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 Table of Contents  
CLINICAL IMAGES
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 91-92

Warner and Wilson-Jones syndrome


Department of Pathology, Maharaja Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India

Date of Web Publication14-Jan-2015

Correspondence Address:
Dr. Ramesh Uppada
Department of Pathology, Maharaja Institute of Medical Sciences, Nellimarla, Vizianagaram - 535 217, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.149363

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  Abstract 

Recurrent pyogenic granuloma with satellite lesions is also known as Warner and Wilson-Jones syndrome. Local recurrences do occur but presenting with multiple satellite lesions is very rare. We provide a characteristic clinical image and microphotographs of a case of pyogenic granuloma with satellitoses in an 18-year-old male who presented with a painful erythematous nodule on his back in interscapular region. A punch biopsy was taken from the lesion and it showed features of pyogenic granuloma. Combining clinical and microscopic features, a final diagnosis of pyogenic granuloma with satellite lesions was made. Surgeons excised the lesion and skin grafting was done which healed well. Three years follow-up of the patient was uneventful

Keywords: Local recurrences, multiple satellite lesions, pyogenic granuloma, Warner and Wilson-Jones syndrome


How to cite this article:
Uppada R, Pullela RV. Warner and Wilson-Jones syndrome. CHRISMED J Health Res 2015;2:91-2

How to cite this URL:
Uppada R, Pullela RV. Warner and Wilson-Jones syndrome. CHRISMED J Health Res [serial online] 2015 [cited 2019 Oct 14];2:91-2. Available from: http://www.cjhr.org/text.asp?2015/2/1/91/149363

The pathogenesis of satellite lesions in recurrent pyogenic granuloma is known as Warner and Wilson-Jones syndrome. [1],[2] Pyogenic granuloma, a common vascular proliferation affecting skin or mucosa usually presents as a solitary lesion.[Figure 1] Local recurrences do occur but presenting with multiple satellite lesions is very rare. We provide a characteristic clinical image and microphotographs of a case of pyogenic granuloma with satellitoses. An 18-year-old male presented with a painful erythematous nodule on his back in interscapular region which was easily bleeding. On eliciting clinical history, he had an insect bite two days back at the site of lesion, while sleeping outside during night. A punch biopsy was taken from the lesion and it showed features of epitheloid hemangioma. Two months later he presented with multiple small nodules surrounding the initial lesion. Further, a 4 mm punch biopsy was taken and showed features of pyogenic granuloma. Combining clinical and microscopic features [Figure 2], [Figure 3], [Figure 4], a final diagnosis of pyogenic granuloma with satellite lesions was made. Surgeons excised the lesion and skin grafting was done which healed well. Three years follow-up of the patient was uneventful. The pathogenesis of satellite lesions is not well know but has been suggested that after either surgical excision or treatment of the primary lesion, angiogenic factors may promote the appearance of new lesions. [3] It has also been observed following irritation of the primary lesion. [4],[5] Good clinical picture and rare presentation of satellite lesions around a primary lesion in pyogenic granuloma made us to send this picture, which can pose a challenge to young clinicians. This provides a clue that a satellite lesion need not always be of infectious or neoplastic etiology and could be due to inflammatory etiology.
Figure 1: Satellite lesions were seen around a primary lesion which was excised earlier. These lesions were seen as erythematous nodules and papules with surface ulceration in some of them

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Figure 2: An elevated nodule with surface ulceration, granulation tissue with congested capillaries and neutrophilic collections. There is typical epidermal collarette with lobules of capillaries above, (H and E, x10)

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Figure 3: Lobules of capillaries in deep dermis. These capillaries are lined by plump endothelial cells, (H and E, x10)

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Figure 4: Capillaries in the lobules lined by plump endothelial cells. Focal neutrophilic aggregates can be seen in stroma in the center, (H and E, x10)

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  References Top

1.
Senser M, Derancourt C, Blanc D, Van Landuyt H, Laurent R. Recurrent pyogenic granuloma or Warner and Wilson-Jones syndrome. Arch Pediatr 1997;4:653-5.  Back to cited text no. 1
    
2.
Warner J, Jones EW. Pyogenic granuloma recurring with multiple satellites. A report of 11 cases. Br J Dermatol 1968;80:218-27.  Back to cited text no. 2
    
3.
Echenique M, Tumeu A, Zubizarreta J, Lobo C Granuloma piogénico recidivante de lesiones múltiples. Actas Dermosifiliogr 2004;95:651.  Back to cited text no. 3
    
4.
Zaynoun ST, Juljulian HH, Kurban AK. Pyogenic granuloma with multiple satellites. Arch Dermatol 1974;109:689-91.  Back to cited text no. 4
    
5.
Blickenstaff RD, Roenigk RK, Peters MS, Goellner JR. Recurrent pyogenic granuloma with satellitosis. J Am Acad Dermatol 1989;21:1241-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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