Corticosteroid injection for pyogenic granuloma of the tongue in a rare resembling ulcerative malignancy: a case report.

backgroundPyogenic granuloma (PG) is a benign vasoproliferative lesion that usually occurs in the skin And mucosa. The clinical manifestations of PG are rapid growth, pedicled or broad base of a single red smooth papule, easily bleeding with minor lesions. Most of the oral lesions occur at the gingiva, And the extra-gingival lesions is less common, and the ulcerative type is even rarer. We present a case of ulcerative lesion located at the lateral margin of the tongue with a peripheral bulge for more than 5 years. It was initially suspected to be tongue cancer and was confirmed to be a PG by microscopic examination, and the ulcer healed and the protrusion subsided after topical steroid corticosteroid injection. CASE PRESENTATION: A 75-year-old woman presented with An ulcer on the right tongue for more than 5 years. Clinical examination revealed a prominence seen on the mid-posterior part of the lateral margin of the right tongue with a tough texture and an ulcerated surface visible in the center. The Lingual cusps of the right lower first And second molars opposite the ulcer was sharp. Interestingly, the patient had undergone partial gastrointestinal resection because of gastric carcinoma And had been on antidepressants for 4 years. Hematoxylin-eosin (HE) staining was suggestive of vascular and vascular endothelial cell hyperplasia in the lamina propria of the ulcer surface, and the pathologic diagnosis was PG. Two injections of triamcinolone acetonide acetate (mixed with lidocaine hydrochloride) were administered at 2-week intervals, combined with topical bovine basic fibroblast growth factor (bFGF) and cetylpyridinium chloride/compound chlorhexidine gargle. Complete healing was observed at 4 weeks, with no recurrence confirmed by telephone follow-up at 6-month and1-year post-treatment. DISCUSSION: Extragingival PGs in the mouth are relatively rare, and longstanding ulcerative protrusions occurring on the lateral margins of the tongue are often recognized as ulcerative tumors, and pathology is necessary to distinguish malignant tumors from PGs. Trauma, altered hormone levels, and medications can all contribute to the development of PGs, and we hypothesize that the sharp dental cusps, altered estrogen secretion, long-term use of antidepressant medications, and partial gastrointestinal resection may contributed to the development of PG in this woman. The conventional treatment for PG is surgical resection. In this case, good therapeutic effect was achieved after using multi-point topical injection of corticosteroid, combined with wet compress, mouthwash, and medication application, which provides clinical basis for the selection of non-surgical treatment for PG.