Abstract
ABSTRACT
We describe a 27 year old female in her second trimester presented with a swelling over left outer pinna or concha for two weeks duration. She has been on antiplatelet agent for antiphospholipid syndrome. She was treated conservatively with antibiotic ointment. The mass was completely regressed after 3 weeks of treatment. (Rawal Med J 2010;35: ).
Keywords
Pyogenic granuloma, granuloma gravidarum, concha.
INTRODUCTION
Granuloma Gravidarum and pregnancy tumor are terms to describe pyogenic granuloma that occurs during pregnancy. These are usually benign, focal reactive lesion comprising of endothelial proliferation within mucosa or skin. We report such a case of a conchal granuloma gravidarum
CASE PRESENTATION
A 27 year old female who was 15 weeks pregnant presented with swelling just over left outer part of pinna or concha for two weeks duration which was progressively increasing in size. There was no preceding trauma, no otorrhea and no otalgia. She had history of miscarriage twice and was diagnosed with antiphospholipid syndrome with previous pregnancy loss and she was on daily antiplatelet medication.
Fig 1. Mass in concha.


On examination, there was a friable mass over the left concha measuring 1.0cm x 1.0cm, inflamed and tender on palpation (Fig 1). Both the external auditory canals were clear and both tympanic membranes were intact. There was no cervical lymphadenopathy.
Fig 2. Mass completely resolved.

The clinical impression was granuloma gravidarum and she was treated with chloramphenicol ointment. During follow up after two weeks, the swelling had reduced to 0.5cm x0.5cm but was still tender on palpation. We decided not to proceed with biopsy as it had already regressed in size and may cause bleeding. A month later the mass was completely resolved (Fig 2).

DISCUSSION
Pyogenic granuloma is an inflammatory hyperplasia. It is a benign vascular skin tumor common in children and pregnant women. It is caused by vascular proliferation and appears as a red sessile or pedunculated mass or skin. Histologically, it is a reactive inflammatory process filled with proliferating vascular channel, immature fibroblastic connective tissue and scattered inflammatory cells. The term is a misnomer because the lesion is unrelated to infection and it is not a true granuloma.1 It arises in response to various stimuli such as low grade local irritation, trauma or hormonal factors. It is also known as granuloma gravidarum or pregnancy tumor when occur during pregnancy.
The granuloma gravidarum most frequently develops on the buccal gingiva in the interproximal tissue between teeth. Three quarters of all oral pyogenic granulomas occur on the gingiva lips, tongue (especially the dorsal surface), and buccal mucosa is also affected. Extragingival granuloma gravidarum are less commonly reported such as mucous membrane, lingual, aural, fingers and toe nail beds. A history of trauma is common in extragingival sites, whereas most lesions

Key words: Pyogenic granuloma, granuloma gravidarum, concha.