Pyogenic Granuloma of the Buccal Mucosa Mimicking an Atypical Vascular Tumor: A Case Report.

Background

Pyogenic granuloma (PG) is an uncommon vascular proliferation that, when it arises intraorally, is predominantly gingival; buccal mucosal involvement is rare. Extragingival PG in elderly patients may mimic malignant vascular tumors.

Methods

We report a 69-year-old woman with a 1.0 cm ulcerated mass of the left lower buccal mucosa that enlarged after biting trauma. The excised lesion was examined histopathologically and by immunohistochemistry for CD31, CD34, D2-40, S100, human herpesvirus 8 (HHV-8), Ki-67, and p53. Reports of buccal mucosal PG published up to December 2025 were reviewed.

Results

The initial pathology report described an atypical vascular tumor with involved margins, requiring exclusion of hemangioendothelioma, angiosarcoma, and Kaposi sarcoma. Immunohistochemistry showed diffuse CD31 and CD34 positivity and preserved S100-positive perilesional nerve bundles, with absent HHV-8, a low Ki-67 index, and no aberrant p53 expression; the diagnosis was formally amended to PG. No recurrence occurred at 9 months despite involved margins. Among 11 previously reported cases, recurrence was documented in 6, none of which recurred.

Conclusions

Buccal mucosal PG may mimic vascular malignancy in elderly patients, and immunohistochemistry can be decisive. Whether prognosis differs by site remains an open question requiring larger series.