Answer : D. Granuloma pyogenicum

Explanation : A pyogenic granuloma is a benign proliferation of immature capillaries occurring at the site of minor skin trauma. The name is a misnomer, as it is neither an infection nor a granuloma. It most commonly occurs in children, young adults, and pregnant women. In pregnant women, it is called granuloma gravidarum.

Reference : Chapter 247. Disorders of the Hands, Feet, and Extremities. In: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e.​

Answer : C. Focal necrotizing glomerulonephritis

Explanation :
Granulomatosis with polyangiitis (Wegener’s granulomatosis):

◘ Three pathologic hallmarks of are granulomatous inflammation, vasculitis, and necrosis.

◘ Classic triad of upper and lower respiratory tract disease and glomerulonephritis.

◘ The histopathologic hallmarks of granulomatosis with polyangiitis are necrotizing vasculitis of small arteries and veins together with granuloma formation, which may be either intravascular or extravascular.

◘ Lung involvement typically appears as multiple, bilateral, nodular cavitary infiltrates, which on biopsy almost invariably reveal the typical necrotizing granulomatous vasculitis.

◘ In its earliest form, renal involvement is characterized by a focal and segmental glomerulitis that may evolve into a rapidly progressive crescentic glomerulonephritis.

◘ Granuloma formation is only rarely seen on renal biopsy.

◘ In contrast to other forms of glomerulonephritis, evidence of immune complex deposition is not found in the renal lesion of granulomatosis with polyangiitis.

Reference : Langford C.A., Fauci A.S. (2012). Chapter 326. The Vasculitis Syndromes. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.