Granuloma piogenico linguale in gravidanza: un caso clinico = Oral granuloma gravidarum of the tongue: a clinical case

OBJECTIVES The aim of this case report is to de scribe an unusual case of granuloma gravidarum involving the border of the tongue. Pyogenic granuloma (PG) is a common benign lesion in the oral cavity, which occur with an increased prevalence in females, especially between the second and fourth decade of life. Pregnant women are often affected by oral PG. The hormonal changes that occur during pregnancy, together with local and chronic irritating factors, contribute into the pathogenesis of oral PG. The typical PG’s clinical picture is represented by a red-purplish mass, variable in size and localized at the gingival tissues in the great majority of cases. Finding this lesion in unusual intra-oral sites may represent a diagnostic challenge for the clinicians. In these cases, the histopathological analysis plays an essential role in order to differentiate benign conditions from malignant or potentially malignant disorders or from oral manifestations related to more severe systemic conditions. MATERIALS AND METHODS The authors describe a case of lingual pyogenic granuloma occurring in a young pregnant woman few weeks prior to childbirth. Despite the unusual onset location, the clinical picture and anamnestic findings led to the clinical diagnosis of pyogenic granuloma induced by pregnancy-related hormonal alterations. The lingual growing-mass was re moved with local anesthesia with no intra-operative and post-operative complications. RESULTS Oral PG can spontaneously regress after childbirth, as the hormonal alterations which sustain this lesion are decreased. However, in this clinical case the oral mass showed a progressive growth even after the childbirth. Considering the episodes of intra-oral bleeding and the impairment in speaking and swallowing due to the size of the lingual lesion, the surgical excision was per formed. This surgical approach, and the subsequent histopathological ex amination, allowed to achieve definitive diagnosis and to reach complete resolution of the clinical case. CONCLUSIONS PG is a reactive inflammatory le sion. For this reason, dental pre vention is essential and it is aimed at eliminating all possible sources of chronic irritation such as plaque, calculus, periodontal pockets or in congruous restorations which can lead to PG onset. More care should be paid in preg nant patients in which, even in ab sence of local irritating factors, hormonal changes are associated with an increased risk of oral PG onset. CLINICAL SIGNIFICANCE Present diagnosis and treatment of a rare clinical case of granulo ma gravidarum of the tongue bor der, showing also the surgical management of the subsequent local recurrence.