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Uncommon Fingertip Pyogenic Granulomas in Pediatric Patients: A Case Series of Metaplastic Ossification
Dean Spyres, MS; Steffi Sharma, MD; Stephanie Russo, MD, PhD
Northeast Ohio Medical University (NEOMED)
2025-01-09
Presenter: Dean Spyres
Affidavit:
As Associate Dean for Student Affairs I certify the student presenter has completed the work as described and this has not been published elsewhere. I have confirmed this with the Program Director, Ananth Murthy, MD
Director Name: Douglas E. Moses, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction:
Pyogenic granuloma (PG) is a benign lobular capillary hemangioma commonly affecting the fingers and lips. PG with metaplastic ossification is rare. We present two pediatric cases of paronychial granulomas with ossification.
Case Presentation:
Case 1: A 6-year-old female presented with swelling of the left middle finger's distal interphalangeal (DIP) joint six weeks post-trauma. Examination revealed a proximal nail fold wound and nail groove. Radiographs showed an elliptical opacity over the distal phalanx. Surgical excision and pathology revealed a lesion (0.5 x 0.4 x 0.2 cm) with capillary proliferation and osseous tissue, consistent with PG with metaplastic ossification (PGMO). At 139 days post-op, no recurrence or nail deformity was noted.
Case 2: A 12-year-old female with history of chronic nail-biting presents with a persistent left middle finger mass for one year who failed prior antibiotic and cryoablation treatments. Examination showed a mass on the radial paronychia with overlying scabbed tissue. Radiographs identified a smooth, oblong ossific structure near the distal phalanx. Excisional biopsy of the lesion (0.6 x 0.1 x 0.1 cm) confirmed PGMO with a central ossified nodule. At 52 days post-op, there was no recurrence.
Discussion:
Persistent digital masses with ossification, though rare, should prompt consideration of PGMO to avoid misdiagnosis as a foreign body or neoplastic condition. PGMO may represent a reactive process triggered by trauma or local tissue injury, potentially leading to metaplastic calcification and subsequent ossification. However, the definitive pathogenesis remains unclear. Surgical excision is effective for ensuring complete removal and preventing recurrence.
