Lobular Capillary Hemangioma: Understanding Your Pathology Report
A lobular capillary hemangioma is a common noncancerous growth made of small blood vessels. It is also called a pyogenic granuloma, an older name that is misleading because the growth is neither an infection nor a granuloma.
These growths are usually round, bright red, and raised. They often appear suddenly and grow quickly over days to weeks, which can be alarming. They do not spread to other parts of the body or turn into cancer.
A lobular capillary hemangioma can develop anywhere. The most common locations are the skin of the fingers, face, and trunk, the lips and inside of the mouth, and the lining of the nose.
This article explains how a lobular capillary hemangioma is diagnosed and what the findings in your pathology report mean.
What are the symptoms of a lobular capillary hemangioma?
The usual finding is a red bump that appeared over a short period. Because the growth is made almost entirely of blood vessels with a thin covering, it bleeds easily, often after minor contact, and the bleeding can be difficult to stop.
Some are tender. A growth inside the nose can cause nosebleeds or a blocked feeling, and one in the mouth can interfere with eating.
What causes a lobular capillary hemangioma?
Many of these growths follow a minor injury such as a scratch, a burn, or repeated rubbing. This is particularly true for growths inside the mouth or nose. For some people, doctors find no cause.
Hormones also play a part. These growths are more common during pregnancy, especially on the gums and lips, and many shrink or disappear after delivery. A growth that develops during pregnancy is sometimes called granuloma gravidarum. Certain medications, including some used for acne and some cancer treatments, can also trigger them.
How is the diagnosis made?
A pathologist usually makes the diagnosis after the whole growth is removed and examined under a microscope. Removal serves two purposes at once, since it treats the growth and confirms what it is.
Under the microscope, the growth is made of many small and medium-sized blood vessels. The small vessels cluster around the larger ones in rounded groups, and this clustered arrangement is what the word lobular describes. This feature gives the growth its name.
The surface layer is often damaged or missing, a finding pathologists call an ulcer. The tissue between the vessels contains fluid and inflammatory cells, including neutrophils, plasma cells, and lymphocytes.
This combination makes the growth resemble granulation tissue, the tissue that forms while a wound heals. For this reason, many doctors consider a lobular capillary hemangioma to be an exaggerated healing response rather than a true tumor.
Is a rapidly growing red lump a concern?
Rapid growth and bleeding are expected for this diagnosis and are not signs of cancer. This happens because the growth has fragile vessels under a thin surface.
A few other lesions can look similar, including a bleeding mole and, rarely, a skin cancer such as melanoma. This is one reason the growth is sent for examination rather than removed and discarded. A pathology report naming a lobular capillary hemangioma means the pathologist has considered and excluded those possibilities.
Margins
A margin is the edge of tissue cut by the surgeon or removed during the procedure. Your report may say that the growth extends to a margin.
For a lobular capillary hemangioma, a positive margin does not carry the meaning it does for cancer. Many of these growths are removed by shaving or scraping them off at skin level, so some tissue at the base commonly remains. This is the main reason the growth can come back in the same spot.
What is the prognosis?
The outlook is excellent. A lobular capillary hemangioma is noncancerous, does not spread, and does not become cancer.
Some disappear on their own, particularly those that develop during pregnancy. Others come back after removal, most often when the growth was removed at the surface rather than at its base. A growth that comes back is still noncancerous and can be treated again.
What happens after the diagnosis?
- Removal. The usual treatment is removing the growth, often along with sealing the base with heat or a chemical to control bleeding and reduce the chance it returns.
- Observation. A growth that appeared during pregnancy may be watched, since many settle after delivery, unless bleeding is a problem.
- Other treatments. Laser treatment and freezing are alternatives for some skin lesions.
- Repeat treatment. If the growth comes back, removing it more deeply usually solves the problem.
Questions to ask your doctor
- Was the whole growth removed?
- Does my report say the growth extended to a margin?
- How likely is it to come back?
- If it comes back, what’s the next step?
- Should I expect the area to bleed while it heals?
- Was my growth related to an injury, a medication, or pregnancy?