Carlo Basilio, MD, MPH1, Nabil Baddour, DO2, John Affronti, MD2
1Tulane University, New Orleans, LA; 2Tulane University Health Sciences Center, New Orleans, LA
Introduction: Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a common benign vascular cutaneous or mucosal lesion. This type of lesion rarely occurs in the gastrointestinal tract. This case describes an asymptomatic patient with PG at the gastroesophageal junction.
Case Description/Methods: A 59-year-old woman with no family history of GI malignancy was referred for evaluation of a positive fecal immunochemical test (FIT). She had occasional dyschezia with blood-streaked stools, as well as alternating between occasional loose stools and constipation. She reported weight loss, but she was unable to quantify the amount or the time period. She has a 40 pack-year history of tobacco smoking. Her vital signs and physical exam were normal. Her labs included Hgb 13.8, MCV 86, and non-reactive for HCV. EGD revealed a 4 mm nodule at the gastroesophageal junction (GEJ), as well as prepyloric localized inflammation. The nodule at the GEJ was consistent with PG, and H. pylori testing was negative. As the patient was asymptomatic without any active bleeding, no further workup was necessary.
Discussion: Only 14 cases of esophageal and 10 cases of gastric PG have been reported. Half of esophageal granulomas were associated with symptoms, including dysphagia, retrosternal pain, hematemesis, and weight loss. Gastric PGs were commonly associated with pain, UGIB, or melena. These lesions can have pseudomalignant features, such as ulceration, as noted in this case. This case demonstrates the importance of understanding PG as part of the differential diagnosis for a positive FIT assay. PGs can be misdiagnosed as a malignant vascular neoplasm, including histopathologic features concerning for malignancy, but it should be considered in the differential diagnosis. The symptoms and features of this lesion can be highly variable, although rare in the GI tract, and gastroenterologists and pathologists must be aware of this to avoid overdiagnosis as a malignant neoplasm.
Citation: Carlo Basilio, MD, MPH; Nabil Baddour, DO; John Affronti, MD. P1241 - A RARE CASE OF PYOGENIC GRANULOMA IN THE GASTROINTESTINAL TRACT. Program No. P1241. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.