HISTOPATHOLOGY
A pregnancy granuloma is composed of capillaries, fibrous tissue, and inflammatory cells, with marked vascularity being the most characteristic histologic feature. As such, distinguishing it from a pyogenic granuloma without other clinical data is difficult. The epithelium is generally thin and atrophic, but may be hyperplastic. If the lesion is ulcerated, it shows a fibrous exudate of varying thickness over the surface and a moderately intense infiltration of polymorphonuclear leukocytes, lymphocytes, and plasma cells. The excessive vascularity accounts for the bright red color, and the hyperemia and edema account for the enlargement.
Differential diagnosis
The differential diagnosis of a small, pedunculated hemorrhagic lesion of the marginal gingival tissue must include the following:
1. Peripheral fibroma
2. Pyogenic granuloma
3. Peripheral giant granuloma
4. Eosinophilia granuloma
5. Lymphomas or leukemic infiltrates
6. Hemangiomas
TREATMENT
It is prudent, if possible, to wait until parturition for surgical excision of a pregnancy granuloma, unless the lesion is creating a functional problem or appears to be having a deleterious effect on the adjacent periodontium. These lesions may regress after birth; however, surgical excision is usually warranted. The surgery can be accomplished safely throughout pregnancy with the use of local anesthesia and most effectively with the aid of lasers in place of scalpel blades. Lasers have the tendency to reduce the postsurgical bleeding typically experienced after excision of a pyogenic granuloma. Incomplete excision results in recurrence. A residual fibrous mass may remain if the lesion is large and is allowed to regress postpartum without surgical intervention.
