Congenital Disseminated Pyogenic Granuloma: Characterization of an Aggressive Multisystemic Disorder.

Objective To describe the clinical, radiological and histopathological features of “congenital disseminated pyogenic granuloma” (CDPG) involving various organs with high morbidity related to cerebral hemorrhagic involvement. Study design We searched the database of the Vascular Anomalies Center at Boston Children’s Hospital from 1999 to 2019 for patients diagnosed as having multiple vascular lesions, visceral vascular tumors, congenital hemangiomatosis, multiple pyogenic granulomas or multiple vascular lesions without a definite diagnosis. A retrospective review of the medical records, photographs, histopathological and imaging studies was performed. Only patients with imaging studies and histopathological diagnosis of pyogenic granuloma were included. Results Eight children (5 male, 3 female) had congenital multifocal cutaneous vascular tumors. Lesions were also found in the brain (n=7), liver (n=4), spleen (n=3), muscles (n=4), bone (n=3), retroperitoneum (n=3) and intestine/ mesentery (n=2). Less commonly affected were the spinal cord, lungs, kidneys, pancreas and adrenal gland (n=1 each). The mean follow-up period was 21.8 months. The cerebral and visceral lesions were hemorrhagic with severe neurological sequelae. The histopathologic diagnosis was pyogenic granuloma with prominent areas of hemorrhage and necrosis. The endothelial cells had enlarged nuclei, pale cytoplasm and were immunopositive for CD31 and negative for D2-40 and GLUT-1. Conclusion Congenital disseminated pyogenic granuloma is a distinct multisystemic aggressive disorder that primarily affects the skin, brain, visceral organs and musculoskeletal system. Differentiation of this entity from other multiple cutaneous vascular lesions is critical because of possible cerebral hemorrhagic involvement.