GRANULOMA PYOGENICUM¹

Synonyms.—Granuloma telangiectodes; Granuloma pediculum; Granuloma pedic-
ulatum; Pseudobotryomycosis; Fr., Botryomycose humaine; Pseudobotryomycose;
Granulome pediculé; Ger., Telangiektatische granulome.

This rather rare, usually pea- to nut-sized, more or less thinly pedic-
ulated growth was first described by Poncet and Dor and later by other
French observers, who looked upon it as analogous to botryomycosis
observed in bovines and other animals, in short, as human botryomycosis.
Soon afterward, however, Sabrazès and Laubie, Jaboulay, Brault, Bodin,
and others succeeded in showing conclusively that the so-called botryo-
mycetes were in reality staphylococci, and since then the designation
“botryomycosis hominis” has given place in French writings to that of
“pseudobotryomycosis.” More recent investigations by Hartzell and
Wile in this country, Lenormant in France, and Heuck and others in
Germany have emphasized the correctness of these later findings. The
lesion is single and, as a rule, appears insidiously and grows slowly; minute
in the beginning, the outer portion—the portion projecting beyond and
above the skin—expands and may reach the size of a pea to a cherry or
somewhat larger; the short pedicle, or portion in and immediately on
and above the surface, remaining slender, sometimes almost thread-like,
seemingly serving the purpose of a channel through which goes material
for nourishing and increasing the size of the growth, and for keeping the
latter attached to the skin. The pedicle may be extremely short, so that
the growth may appear to be sessile. The surface of the small tumor
may be more or less rounded and smooth, or irregular and fungoidal,
and even lobulated, its enveloping membrane thin, frequently shiny and

¹ Important Literature: “ Poncet et Dor, Botryomycose humaine,” Trans. XI,
French Surg. Cong., 1897; Bodin, “ Sur la botryomycose humaine,” Annales, 1902, iii, p.
289, and Semaine mêd., 1902, No. 14, p.. 14; Hartzell, “Granuloma pyogenicum,” Jour.
Cutan. Dis., 1904, p. 520 (4 cases with brief review and case and histolog. illustrations);
Küttner, “Ueber, telangiektatische Granulome,” Brun‘s Beiträge z. klin. Chir., 1905,
xlvii, p. 1 (4 cases); Kreibich, “Ueber Granulome,” Archiv. 1909, xciv, p. 121 (4 cases);
Wile, “Granuloma pyogenicum,” Jour. Cutan. Dis., 1910, p. 662 (2 cases, with brief
review of the Hartzell, Küttner, Reitmann, Kreibich and Jacquet and Barré cases;
with histolog. illustrations, and bibliography); Lenormant, “Sur la prétendue botryomy-
cose humaine,” Annales, April, 1910, p. 161 (5 cases with case and histolog. illustrations;
full résumé and review with references—collected 126 cases of the disease from litera­
ture); Heuck, “Ueber Granuloma pediculatum”; Sogenannte, “Menschliche Botrymy-
lose,” Dermatolog. Zeitschr., March, April, and May, 1912 (an exhaustive paper;
records 2 cases of his own, with histolog. findings; reviews all the reported cases in the
literature).

FIBROMA

693

usually bright to dark red in color, and either dry or slightly damp or
moist to the touch; in occasional cases superficial ulceration and crusting.
Occasionally it is quite dark in color. Sometimes it has the appearance
of a pedicled proud-flesh formation; and it may, in the larger spread-
out formation, present a clinical resemblance to the strawberry-like
growth seen occasionally developing at the site of a recent vaccination.

It doubtless takes its origin at the point of a slight abrasion or
injury, is probably always the result of suppuration, insignificant or
unnoticeable, as it may be. It is a persistent formation, and, as a
rule, when torn off its pedicle immediately begins to grow again. It
is most commonly seen on the hands and feet, but it may occur on
any part of the body and even on the lip. Its inconvenience and its
being so easily disturbed and knocked are its chief discomforts. Prac­
tically all the investigators have found the growth to be a granuloma,
consisting of granulation tissue rich in blood-vessels and, to a somewhat
less extent, in fibrous tissue, with pus cocci, usually the staphylococcus
aureus, present in variable quantity, and which are generally considered
the inciting cause. The minor histologic differences depend largely
upon the degree of vascularity and inflammation. Heuck thinks his
histologic study warrants a division into two groups: the simple type,
with conditions just described, and the angiomatous type, with similar
findings plus a marked tendency to the formation of large blood chambers.
The apparently etiologic pyogenic factor led Hartzell and Crocker to
give the malady the convenient name “granuloma pyogenicum,” while
on account of the prominence of the vascular feature Küttner, Reit-
mann, Kreibich, and other German observers have favored the designa­
tion “granuloma telangiectodes.”

Prognosis and Treatment.—If let alone the formation is apt to
be persistent, but it usually yields quickly and successfully to removal
by curet or other means, with supplementary cauterization of the
point of origin; the latter seems essential in most instances, otherwise a
regrowth commonly takes place.

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