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Competing Interests: Competing interests: None declared.

Background: Conditions that present as a 'swelling' in the oral cavity are relatively common, and patients may seek initial assessment from their general practitioners., Objective: The aim of this article is to provide an overview of common causes of a 'swelling' in the oral cavity to help with formulating a differential diagnosis and stratifying the urgency of referral., Discussion: Pathological conditions in the oral cavity (excluding mucosal presentations) may present as a swelling in the submucosa or jaws, symptoms related to teeth and/or gums or an incidental finding on imaging. In this review, the authors outline the most common submucosal or jaw swellings, organised according to their clinical presentations, and describe their typical appearance and management.

Pyogenic granuloma (PG) generally appears in the skin or oral cavity, but rarely occurs in the small intestine, where it can cause bleeding. To date, only 35 cases of small intestinal PG have been reported in the English literature. We retrospectively collected information from the clinical records of seven cases of small intestinal PG that were managed in our hospital and summarized the characteristics. Further information on the clinical characteristics was obtained from the literature. Capsule endoscopy, useful for identifying the source of hemorrhage in obscure gastrointestinal bleeding, can detect PGs. Treatment can often be accomplished with endoscopic mucosal resection.

Pregnancy pyogenic granuloma is considered a benign common growth that usually develops on the gingiva in the second and third trimester of gestation, in response to local irritation, trauma or hormonal factors. Here, the authors report a case of a primigravida who presented an extragingival pyogenic granuloma with a rapid progression in the post-partum. The occurrence on the lower lip in the first few days after delivery was a relatively rarity in the present case which provoked a meaningful state of anxiety and cancerophobia to the female. Complete excision was curative and brought immediate relief of pain and discomfort. This clinical report highlights the possibility of pyogenic granuloma presenting like a rapid-growing mass on the lip and the importance of clinical differential diagnosis of such presentation in this atypical location.

Purpose: To report a case of pyogenic granuloma associated with ocular acne rosacea., Design: Case report., Methods: Interventional case report., Results: The patient developed an unusual lesion of the conjunctiva and limbus, histologically confirmed to be pyogenic granuloma. Excision of the lesion resulted in symblepharon formation, adhesions between lid margins, tarsal conjunctiva, and cornea, and reductions in visual acuity. The patient underwent surgical separation of the corneal lid adhesions with a mucosal autograft for the tarsal conjunctiva and an amniotic membrane graft for the cornea with good results., Conclusions: Ocular rosacea is a common condition but such excessive and unusual fibrotic healing responses following excision of pyogenic granulomas have not been previously reported. This case demonstrated significant morbidity and decreased visual acuity. However, early recognition and effective surgical management can lead to good visual outcomes.

A rare case of regression of a lesion resembling pyogenic granuloma after endodontic treatment of a maxillary lateral incisor in a 16-year-old female patient is reported. After clinical and radiographic examination, the maxillary right lateral incisor was endodontically treated in two visits. At the second visit, clinical regression of the exophytic lesion was evident and the size of this lesion had been greatly decreased, so was not biopsied. After 3 weeks, the exophytic lesion had totally disappeared. This case report indicates that surgical excision of exophytic lesions resembling pyogenic granuloma is not necessary in all situations.

There are a vast number of changes to the female body that occur during pregnancy, to which any pregnant woman will attest. The changes, although considered, for the most part, physiological and not pathological, are quite distressing to many women. This chapter serves to review those changes and comment on their physiological origins. Most of these changes can be definitively or inferentially linked to the dramatic hormonal changes that take place to support a pregnancy. Comments are also made about treatment as they pertain to pregnant women. In addition, a brief discussion about performing cosmetic procedures during pregnancy is included.

The endocrinologic, immunological, and vascular changes that occur during pregnancy are far-reaching. These systemic factors produce profound local impact on the physiology and pathology of the oral cavity, vagina, and vulva. Physiological changes can be expected and tolerable or of such severity that they are viewed as pathological. Existing disease can be exacerbated and dermatoses specific to pregnancy can erupt. Each of these conditions can pose potentially challenging treatment considerations.

We herein report 2 cases of multiple lobular capillary hemangiomas after scalding. The patients exhibited papules and nodules on the scalded areas after healing. Histopathological examination of the lesions showed capillary proliferation in the upper dermis with edematous stroma containing inflammatory infiltrates predominantly composed of neutrophils. Biopsy tissue and secretion specimens from lesions of case 1 were cultured for bacteria, and both grew Enterobacter cloacae. Ultrastructural examination revealed features typical of a lobular capillary hemangioma and viral inclusion bodies in the epidermis of case 1. Multiple lobular capillary hemangiomas after scalding are rarely reported. Trauma may play an important role in the development of this rare condition. Accumulation of similar cases and its precise observation is needed to confirm the associations and to establish an etiological link between the disease and the pathogens.

Objectives: The molecular mechanism for the regression of pregnancy pyogenic granuloma after parturition remains unclear. It has been proposed that, in the absence of vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2) causes blood vessels to regress. Therefore, we investigated the roles of Ang-2 and VEGF in the regression of pregnancy pyogenic granuloma., Materials and Methods: The effects of tumor necrosis factor-alpha (TNF-alpha) on the transcription of Ang-2 were tested in endothelial cells by reverse transcriptase-polymerase chain reaction. A total of 15 specimens, including granulomas taken from five gravidas during pregnancy, five after parturition, and five from normal gingiva were compared by immunoblot assays for their relative expressions of Ang-1, Ang-2, Tie-2, VEGF, and beta-actin. Double staining, immunohistochemistry for Ang-2, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling for apoptotic cells, were used to evaluate their regression. Finally, a fibrin gel culture system was used to investigate whether the withdrawal of VEGF and addition of Ang-2 could cause newly grown microvessels to regress., Results: TNF-alpha upregulated the expression of Ang-2 in all endothelial cell types tested. The protein levels of Ang-2 and Tie-2 were highest in the granulomas in pregnancy, followed by those after parturition and normal gingiva, while Ang-1 and beta-actin exhibited no significant differences. The amount of VEGF was high in the granulomas in pregnancy and almost undetectable after parturition. Double staining on granulomas after parturition revealed more apoptotic cells and less Ang-2 than did those in pregnancy. In the fibrin gel assay, VEGF alone or in combination with Ang-2 could protect microvessels from apoptosis, while Ang-2 alone had no effect., Conclusions: Our findings suggest that a lack of VEGF is associated with apoptosis of endothelial cells and regression of granuloma. The roles of Ang-2 require additional study.

A clinicopathological survey on pregnancy related tumours was carried out on 400 randomly selected pregnant Nigerian women. Fifteen (15) cases of pregnancy granuloma or 'epulis gravidanum' were found. Of these subjects, 287 representing 71.8 percent were on birth control before conception, while 113 or 28.2 percent were not. Nine (9) cases of pregnancy tumour were found in the group on birth control pills and six (6) in the group not on birth control representing an incidence of 3.1 and 5.3 percent respectively. Literature review indicate a general incidence of between 0-2.5 percent. Five of the granuloma regressed post partum, while ten were excised. Patients were followed 1-2 years post partum and no recurrence was recorded, even in patients who have re-commenced on contraceptives.

Endomucin is an endothelial sialomucin that was recently identified with the help of monoclonal antibodies raised against mouse endothelial cells. Cloning of human endomucin allowed us to generate monoclonal antibodies against soluble recombinant forms of human endomucin. In this study, we investigated the expression of this novel molecule in human skin under different conditions, using the monoclonal antibodies. In normal human skin, endomucin was detected for the monoclonal antibody L6H10 by immunoblotting, and immunohistologic analysis of wax-embedded sections revealed that this glycoprotein is expressed on capillaries, venules, and lymphatic vessels. Interestingly, staining of arterial endothelium was either weak or focal using the monoclonal antibodies against endomucin. In situ hybridization of normal human skin confirmed the expression pattern on the messenger RNA level obtained above. We further analyzed the expression of endomucin in skin biopsy specimens from patients with inflammatory skin diseases, such as atopic dermatitis, psoriasis, lichen planus, cutaneous lupus erythematosus, and T cell lymphoma as well as with vascular skin tumors, such as hemangioma, pyogenic granuloma, angiolipoma, Kaposi's sarcoma, and angiosarcoma. We found endomucin expressed on the endothelium of each tissue, concluding that this novel molecule is a new endothelial-specific marker in the study of normal and diseased human skin.

Background: Lobular capillary hemangioma (LCH) usually occurs in the skin or mucous membranes as a rapidly growing red nodule. LCH is one of the most common vascular lesions in the oral mucosa. Tie2 is a novel, human endothelial receptor tyrosine kinase which may play an important role in blood vessel formation. In this study, we investigated its immunohistochemical expression in LCH of the oral mucosa., Methods: Double immunostaining with anti-CD34 and antialpha smooth muscle actin (SMA) antibodies was performed to characterize the cellular expression of Tie2 in 15 cases of this condition., Results: We found Tie2 immunoreactivity in the ovoid cells only, which were frequently intermingled with alphaSMA-positive cells, especially in the hypercellular portion of LCH., Conclusions: These results suggest that the expression of Tie2 in ovoid cells and the interaction between ovoid cells and alphaSMA-positive cells play an important part in the development and progression of LCH.

Basic fibroblast growth factor (bFGF) is thought to play an important role in wound healing. However, its histological localization, both in normal and pathological conditions in the oral mucosa, has not been well documented. We have studied the immunolocalization of bFGF in normal gingiva and gingival epulis specimens corresponding to different organizing stages. In normal gingiva, bFGF was detected in subpopulations of macrophages, mast cells and most endothelial cells in the lamina propria. Granulation tissue in epulides was histopathologically classified into six organizing stages. In stages 1 and 2, a small number of bFGF-positive macrophages was seen at the periphery of ulcer bases. In stages 3 and 4, histologically characterized by prominent capillary proliferation, large numbers of bFGF-positive macrophages and mast cells were located within granulation tissue. A positive reaction for bFGF was also found in some endothelial cells and in myxoedematous stroma that was rich in heparan sulfate proteoglycan. In stages 5 and 6, when fibrosis was accelerated, bFGF-positive macrophages and mast cells decreased in number and were localized only at the periphery of the fibrous tissue. These findings suggest that maximum amounts of bFGF are synthesized and released from some macrophages and mast cells into the extracellular matrix during neovascularization of granulation tissue.

Ten samples of pyogenic granuloma and 10 of normal skin from age- and sex-matched controls were grafted onto the chick embryo chorioallantoic membrane (CAM) to investigate their possible angiogenic activity. The angiogenic response in pathological and control implants was assessed on histologic sections by a planimetric point-count method 4 days after grafting. The CAM mast cells were also quantified. The vascular counts in the area underlying the pyogenic granuloma were four times higher than those of normal skin. A higher number of mucosa-like mast cells was detected in the intermediate mesenchyme of the CAM in pathological samples in comparison to controls. Pyogenic granuloma may promote angiogenesis leading to release of several angiogenic factors. The role played in angiogenic response by the inflammatory cells, mainly mast cells, forming the perilesional infiltrate was supported by this study.

The epulis gravidarum, or granuloma of pregnancy, represents a vascular lesion observed during gravidism. While histologic features may mimic those of generic pyogenic granulomas, the management may differ. Remarkably, the plastic surgical literature is conspicuously void of information concerning this common entity, with approximately 40 new cases being diagnosed and treated annually at our institution. With a review of the literature, we offer four typical and representative case reports that serve to highlight the pertinent physiology and treatment options. Guidelines are proposed to assist in the management of this disease process.