What is the pathophysiology of pyogenic granuloma (lobular capillary hemangioma)?

Updated: Feb 21, 2020
  • Author: Joseph C Pierson, MD; Chief Editor: William D James, MD  more...
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The precise mechanism for the development of pyogenic granuloma (lobular capillary hemangioma) is unknown. Trauma, hormonal influences, certain medications, viruses, underlying microscopic arteriovenous malformations, the production of angiogenic growth factors, and cytogenetic abnormalities have all been postulated to play a role. The overexpression of transcription factors P-ATF2 and STAT3 also may play a role in tumorigenesis. [2] Endothelial nitric oxide synthases (eNOS), CD34, and CD105/endoglin expression are markers of angiogenesis in pyogenic granulomas. [3, 4] . Tissue injury may trigger pathologic angiogenesis driven by FLT4, a tyrosine-kinase receptor, and the nitric acid pathway. [5] COX-2 and IL-10 may be involved in the etiopathogenesis of oral pyogenic granulomas. [6]  BRAF and RAS mutations have been identified, suggesting a true neoplastic process. [7, 8]  The pathogenesis of pyogenic granuloma may be due to autophagy. [9]

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