A 27-year-old woman who is NOT pregnant had a gingival swelling excised; it has now recurred. The original histology showed proliferating vascular tissue. Most likely diagnosis?

Correct answer: B. Pyogenic granuloma

• A. A peripheral ossifying fibroma contains mineralized product — bone or cementum-like material — within a fibrous stroma, not a purely vascular proliferation.
• B. CORRECT. A pyogenic granuloma is a reactive proliferation of granulation tissue — lobular capillary hemangioma histologically — presenting as a soft, red, readily bleeding gingival mass. It is well known for recurring after excision, particularly when the local irritant is not removed or the excision does not extend to periosteum.
• C. A peripheral giant cell granuloma also recurs and also arises on gingiva, but its histology shows multinucleated giant cells in a fibrous stroma, and it is typically more blue-purple. The stem specifies vascular proliferative tissue.
• D. An irritation fibroma is a firm, pale, collagenous nodule with little vascularity and rarely recurs if the irritant is removed.

Note: Recurrence is almost always a technique or aetiology problem rather than tumour biology. Excise down to periosteum, scale the adjacent root surfaces thoroughly, and remove the source of irritation — overhanging margin, calculus, orthodontic appliance. Pregnancy-associated lesions may be observed until postpartum, but this patient is not pregnant, so definitive excision is appropriate.