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Oral Pathology:  Soft Tissue Case #33

 

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Patient: Adolescent male.

Chief Complaint:
The patient is concerned about a soft tissue enlargement on the upper lip. The lesion is nontender, has been present for about ten days, and is questionably larger than when first noted. The patient reports that the lesion bleeds while eating. The patient injured the area immediately before he first noticed it.

Medical History:
No abnormalities are identified.

Dental History:
The patient was treated by a dentist three or four months ago.

Clinical Findings:
The lesion is a well-circumscribed, easily bleeding soft tissue enlargement located on the right upper lip. The lesion is nontender, compressible, and fixed to the surface mucosa and underlying structures. The surface of the lesion has a crust which is rough to palpation and rubs off with firm pressure. The areas of the lesion that are not covered by a crust will blanch upon pressure.

Clinical Images
upper lip with soft tissue enlargement close-up of upper lip, everted, with lesion
Upper Lip with Soft Tissue Enlargement Close-up of Upper Lip, Everted, with Lesion

 

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
The patient complains of a well-circumscribed, non-tender, compressible, easily bleeding soft tissue enlargement on the right upper lip of ten days duration.  The patient reports injuring the area shortly before he first noticed it and states that the lesion is growing larger in size.  Clinically, it is found to have a crust which is rough to palpation and rubs off with firm pressure.  The portion of the lesion not covered by a crust blanches upon pressure.

Lesions to Exclude from Differential Diagnosis:
The lesion is described as a soft tissue enlargement.  It has a rapid growth rate and is associated with injury, which are features of reactive lesions.  However, the lesion is well-circumscribed, non-tender, persistent and progressive and should be classified as a tumor.   

Within the category of tumors, malignant tumors and soft tissue cysts may be excluded.  Malignant tumors are excluded because these lesions infiltrate into underlying structures and are more likely to be painful.  Soft tissue cysts may also be eliminated because they grow slowly and do not blanch nor bleed easily.

Benign epithelial tumors and benign salivary gland tumors can be eliminated because these do not blanch or bleed easily.

Within the category of benign mesenchymal tumors peripheral ossifying fibroma, and peripheral giant cell granuloma can be excluded based on their location.  Leiomyoma may be eliminated because they grow slowly.  Fibroma, rhabdomyoma, lipoma, neurofibroma, schwannoma, granular cell tumor are excluded because they grow slowly and do not blanch or bleed easily.  Hemangioma and lymphangioma can be excluded because these are congenital and only grow rapidly during the first few years of life.  Neuroma can be eliminated because they are firm, tender to palpation, grow slowly, and do not blanch or bleed easily.  Congenital epulis is excluded because they are congenital and occur on the gingiva.  A benign, rapidly growing, easily bleeding, blanching tumor on the lip is suggestive of pyogenic granuloma.

Final Diagnosis:
Pyogenic Granuloma

Management: Treatment is excisional biopsy and microscopic diagnosis.  The lesion may recur but is completely benign and has an excellent prognosis.