An Insight into pyogenic granuloma with ossification: exploring a unique association

Pyogenic Granulomas (PG) are reactive hyperplastic lesions that are formed in relation to some chronic irritation, physical trauma or hormonal factors. The PG may present in various clinical and histological forms. These often present as a smooth lobulated exophytic lesions and at times may show a marked resemblance to Peripheral Ossifying Fibroma (POF). However, the characteristic histologic presentation helps in differentiating both the lesions. Microscopically, presence of ossification in pyogenic granuloma is not common and could possibly indicate an altered response of the connective tissue stroma. The present case report shows occurrence of pyogenic granuloma in a 12-year-old female which on histological examination not only exhibited proliferating blood vessels, endothelial cells and inflammatory cells which are typical features of pyogenic granuloma but also exhibited areas of ossifications which are not frequently encountered in PG. It is important to explore the underlying aetiological factors that could lead to formation of such ossifications. It has been suggested that pyogenic granuloma and peripheral ossifying fibroma could represent part of same spectrum of focal reactive lesions. However, it is still considered that these two lesions are separate clinical entities and the histologic presentations are different and unique to both of them.