gms | German Medical Science

Overview: Intravascular masses in the hand are uncommon and rarely reported on.Intravascular pyogenic granulomas were initially described 37 years ago by Cooper and others. In 2008 four cases were described in the hand and two fingers. Its incidence is related to the use of oral contraceptives or during pregnancy and, so far, its pathogenesis is unclear. It presents clinically as a small, soft, volar nodule. Definitive diagnosis is only made by histological analysis. Treatment is necessary since it may cause alterations in grip strength and range of motion of the fingers. These nodules can also contain elements of Masson tumor, so complete surgical resection is indicated. This paper presents the case of a 65 year old patient with a mass resulting in an intravascular pyogenic granuloma and a review of the medical literature pertaining to the subject

Case Report: The patient is a 65 year old male with no relevant medical history, who sustained a penetrating wound eight months before consulting. A splinter entered the thenar region of his left hand as he supported his weight on a staircase railing. The patient removed it completely, but soon noticed that a mass with progressive growth that developed at the puncture site (Figure 1).The patient consulted for pain when grasping, which limited hand function. Upon clinical evaluation a slightly mobile, non-painful, well defined mass, approximately 2X3 cm in size, and negative to trans-illumination was found in the palmar aspect of his hand. Finger range of motion was normal. Hand x-ray was unremarkable and an ultrasound reported a well-defined, hyper-ecogenic lesion in the thenar area. The mass was completely ressected through a volar approach at the base of the thumb. A firm, well-defined, irregular mass of approximately 2 x 0.5 cm was obtained (Figure 2). Histological examination revealed a vascular tumor composed of wide spaces divided by thick walls with endovascular proliferation and endothelial hyperplasia and some hemosiderophages (Figure 3). These findings are considered to be characteristic of a benign vascular tumor compatible with an intravascular pyogenic granuloma.

Results and Conclusions: Although the pathogenesis of pyogenic granulomas is unknown it should be suspected in patients who are pregnant or undergoing hormone replacement therapy. The intravascular variant is rare and clinically presents as a single, small, soft, slightly mobile, subcutaneous nodule, which should be completely removed because it has been related to Masson tumors.