Periorbital Intravenous Lobular Pyogenic Granulomas: A Case Report and Literature Review of This Peculiar Pathology.

Intravenous lobular pyogenic granuloma (ILPG) is a seldom-documented pathology in oculoplastic and orbital literature. This study aims to elucidate the clinical presentation and histopathologic findings surrounding periorbital ILPG through a case presentation and literature review. We describe a 42-year-old male with a palpable periorbital subcutaneous nodule that was subsequently diagnosed as ILPG on immunohistochemistry. A literature review was performed by searching articles in the PubMed/MEDLINE database using the keywords "periorbital intravenous lobular pyogenic granuloma," "periorbital intravenous pyogenic granuloma," or "periorbital intravenous capillary hemangioma." The literature review identified 6 patients presenting with similar subcutaneous nodules that were diagnosed as periorbital ILPGs. All patients, including the one in this study, were treated with local excision. Only 1 patient (1/7; 14.3%) noted pain while 5 experienced swelling or fluctuance (5/7; 71.4%). In patients with documented pathology reports, all ILPGs involved the angular vein (6/6; 100%). Of the 3 patients who had follow-ups at 2 to 7 years postexcision, none had recurrence. Histopathologic findings demonstrate an intravascular lobular tumor composed of capillaries with endothelial cells and pericytes. Marked reactivity to anti-Wilms tumor type 1 (WT-1) and anti-Smooth muscle actin was noted in the capillary structure. ILPG can be included on the differential for well-circumscribed, subcutaneous periocular masses. While the etiology of periorbital ILPG is unknown, most cases are managed with surgical excision, and recurrence appears to be uncommon. In sharing these cases and histopathologic underpinnings of periorbital ILPG, we endeavor to describe this peculiar pathology for oculoplastic and reconstructive surgeons.