A large pyogenic granuloma with extensive maxillary bone resorption penetrating the maxillary sinus: A rare case report

Oral pyogenic granuloma, also known as lobular capillary hemangioma, is a common benign lesion in the oral cavity. Although the etiopathogenesis of oral pyogenic granuloma remains to be determined, it is speculated to be one of the inflammatory hyperplasias that arise in response to stimuli such as traumatic injury or hormonal factors. We recently experienced a gingival lesion in a 49-year-old female that presented diagnostic difficulties and was finally diagnosed as an oral pyogenic granuloma. The lesion had been initially suspected to be a malignant tumor or arteriovenous malformation because of severe bone resorption of the maxilla or its throbbing. Due to the hypervascularization of this lesion, transarterial embolization was carried out, followed by surgical excision. Pyogenic granuloma with bone resorption is quite rare and to the best of our knowledge has never been reported with extensive maxillary bone resorption penetrating the maxillary sinus. With regard to possible etiologies of this lesion, chronic stimulation by unstable tooth root that was bridged to adjacent teeth and/or a hormonal imbalance caused by progestin, which the patient has taken for many years for the treatment of endometriosis were suspected to be involved.