A 27-year-old woman who is not pregnant had a gingival swelling excised, and it has now recurred. Histology described vascular granulation tissue with acanthotic surface epithelium. What is the MOST likely diagnosis?

Correct answer: A. Pyogenic granuloma

• A. CORRECT. PYOGENIC GRANULOMA is a reactive proliferation of highly vascular GRANULATION TISSUE in response to local irritation (calculus, overhang, trauma) and hormonal influence. It is red-purple, soft, and bleeds readily. It has a notable RECURRENCE rate when excision is incomplete or the local irritant is not removed — which is exactly the history described. Definitive treatment is excision down to periosteum plus thorough scaling and root planing to eliminate the source.
• B. Peripheral giant cell granuloma is typically more blue-purple, occurs only on gingiva/alveolar ridge, may cause superficial 'cupping' bone resorption, and shows MULTINUCLEATED GIANT CELLS histologically — not described here.
• C. Kaposi sarcoma occurs in immunocompromised (especially HIV) patients as a purple macule or nodule, most commonly on the palate, with spindle cells and HHV-8.
• D. Peripheral ossifying fibroma is firmer, pink, arises from the interdental papilla, and contains calcified/osseous material histologically.

Note: The four reactive gingival lesions to keep straight: pyogenic granuloma, peripheral giant cell granuloma, peripheral ossifying fibroma, and fibroma/irritation fibroma.