This lesion from the neck of a 4-year-old boy had a history of rapid growth. Pyogenic granulomas often occur on the extremities following trauma. They may also occur on the gingiva of pregnant women. The histology in this case is typical, although more inflammatory ones are not uncommon. We sign these out as lobular capillary hemangiomas (pyogenic granulomas). Also of note, we have had several amelanotic melanomas that were clinically thought to be pyogenic granulomas.
At higher power, the lesion consists of condensed small-caliber vessels with scattered red blood cells. The stroma is fibromyxoid with scattered inflammatory cells. Cytologic atypia and mitoses are not present, but can be seen.