Intravascular papillary endothelial hyperplasia of the mouth: report of six cases and literature review

An Uncommon Great Pretender in Oral Cavity Lesions: The Masson's Tumor

Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign non-neoplastic vascular lesion. A typical presentation consists of a subcutaneous nodule that may simulate other clinical entities. Presentation in the oral cavity is uncommon. It is thought to develop as an abnormal proliferative reaction of endothelial cells in a process of impaired thrombogenesis. When endothelial proliferation occurs, a differential diagnosis with a soft tissue sarcoma, in particular an angiosarcoma, should be performed. We report a case of a 68-year-old female patient who presented with a lesion on the upper lip of 3 months' duration. Surgical resection revealed an IPEH. 1 year later, the patient showed a local recurrence requiring excision with clear margins. Pathological and immunohistochemical features can help us distinguish these lesions from those requiring more aggressive treatment. The gold standard is surgical resection with clear margins. Accurate preoperative diagnosis is essential to avoid overtreatment. Emphasis should be placed on clinical, radiological and histological studies.

The color of skin: blue diseases of the skin, nails, and mucosa

Diseases of the skin, hair, nails and mucosa can appear as flesh-colored lesions or may present as any of the colors of the visual spectrum. Diseases associated with blue (or shades of blue) discoloration represent a unique group of conditions that occur de novo or as a reaction to either a topical or a systemic agent to which the individual has been exposed. Blue diseases can affect the skin, the nails or the mucosal membranes of the mouth (buccal mucosa, gingiva, lips, palate or tongue) or eyes (sclera). In addition to appearing blue, they can also appear as blue-black, blue-brown, blue-gray, blue-green, blue-purple, blue-red, and blue-silver. The conditions range from those secondary to exogenous agents (systemic or tattoo or topical) to syndromes to systemic diseases to tumors (adnexal, melanocytic, vascular, or miscellaneous). A comprehensive attempt to include all conditions that have been described as blue (or a shade of blue) has been performed by evaluating the following terms using the medical search engine PubMed: blue and either gingiva, lips, lunula, mucosa, nails, oral, palate, sclera, skin, or tongue. Subsequently, the conditions were organized by color (blue and shades of blue) and within each color by location (skin, nails, oral mucosa and sclera). The results are presented in organized tables; in addition, there is discussion of some of the conditions that are unique to one or more specific locations. In conclusion, 'preserve and cherish the pale blue dot' and remember that a big red rock eater with chrysiasis is the answer to the riddle, "What is big and blue and eats rocks?"

Masson's Hemangioma of the Cheek: A Case Report

We report a rare case of intravascular papillary endothelial hyperplasia (IPEH) of the cheek. This neoplasm, known as Masson's tumor, is an unusual vascular lesion of proliferating endothelial cells. It is usually confined to the lumen of preexisting vessels or vascular malformations. The principal significance of IPEH is its resemblance to a variety of benign and malignant diseases and possible misdiagnosis as such. Achieving a correct diagnosis is essential to avoid subjecting a patient to either unnecessarily aggressive or inadequate therapy. For this reason, awareness of this lesion is very important.

Orbital intravascular papillary endothelial hyperplasia in a Nigerian child: a case report and review of the literature

INTRODUCTION

Intravascular papillary endothelial hyperplasia is a reactive proliferative lesion of endothelial cells in blood vessels. It typically presents as a painless, reddish purple lesion in the sites affected. The orbit remains an uncommon site of affectation of this relatively common disease. It is noteworthy that this is the first reported case, to the best of our knowledge, of orbital intravascular papillary endothelial hyperplasia in a Nigerian child.

CASE PRESENTATION

The case reported here is an orbital intravascular papillary endothelial hyperplasia causing non-axial proptosis and loss of vision in a 14-year-old Nigerian boy. We describe the clinical and histological findings of intravascular papillary endothelial hyperplasia in the orbit of this 14-year-old boy. The key distinguishing features are discussed and relevant literature is reviewed.

CONCLUSION

Although unusual in presentation, intravascular papillary endothelial proliferation should be considered in the list of differentials of proptosis due to mass lesion in young Nigerians and, possibly, Africans.

Intravascular papillary endothelial hyperplasia of the lower lip: surgical approach and review of the literature

OBJECTIVE

A review of the literature for intravascular papillary endothelial hyperplasia is presented along with a case report of a geriatric patient.

REVIEW OF THE LITERATURE

Intravascular papillary endothelial hyperplasia (IPEH) is a reactive benign lesion of vascular origin, which is caused by an excessive proliferation of endothelial cells. Only a few cases with IPEH in the oral cavity have been recorded in the literature, reporting the lower lip as the main site. The treatment of choice mentioned in the literature is simple excision.

CASE REPORT

In this case, an IPEH of the lower lip of a 79-year-old male was treated by a sclerosing agent, which was injected into the lesion, causing compression and fibrosis of the blood vessels, followed by a careful dissection and excision. Intra-operatively no bleeding occurred. Post-operatively an excellent aesthetic result was achieved, without recurrence.

CONCLUSION

The use of sclerotherapy followed by surgery in mixed type intravascular papillary endothelial hyperplasia can provide an acceptable aesthetic result with minimal intra-operative bleeding.

Extravascular Papillary Endothelial Hyperplasia of the Larynx: A Case Report and Review of the Literature

Papillary endothelial hyperplasia (PEH), a tumor that falls along the spectrum of reactive to neoplastic vascular lesions, must be diagnosed carefully because it can resemble an angiosarcoma. PEH is generally considered to be the result of an unusual form of thrombus organization, exhibiting excessive papillary endothelial proliferation that is usually confined to the lumen of preexisting vessels or vascular malformations. Most cases of PEH are of the intravascular type; extravascular PEH is rare. We describe what we believe is the first reported case of an extravascular PEH in the larynx.

Left ventricular haemangioma with papillary endothelial hyperplasia and liver involvement

An intracardiac haemangioma with papillary endothelial hyperplasia (PEH) and liver involvement has not been previously reported in the English literature. This report describes a 65 year old man with a left ventricular haemangioma with PEH coexistent with multiple nodular hepatic haemangiomas. Transthoracic and transoesophageal echocardiography identified a large tumour in the left ventricular cavity with a pedicle connected to the apex. Abdominal sonography also identified multiple hyperechoic hepatic tumours. Magnetic resonance imaging showed hypervascularity of both the cardiac and hepatic lesions. The left ventricular tumour was totally resected and the liver nodules were biopsied. Tissue pathological study showed that both the left ventricular tumour and liver lesions were haemangiomas with PEH. The patient was discharged without complications postoperatively.

Rare vascular proliferations of the oral mucosa

Benign vascular lesions-malformative, reactive, and neoplastic-are fairly common in the oral soft tissues; nevertheless, extravascular papillary endothelial hyperplasia and sinusoidal hemangioma have not been reported in this location. To our knowledge, a single case of intraoral spindle cell hemangioma has appeared in the literature. This report deals with histopathological features of these rare vascular proliferations involving the oral mucosa.

Intravascular papillary endothelial hyperplasia arising from the upper lip

We report a rare case of intravascular papillary endothelial hyperplasia (IPEH) arising from the upper lip. Pathologically, it consisted of a few lobulated masses lined by an incomplete fibrous capsule of variable thickness which was separated from the surrounding tissue and which partially formed papillary structures bearing fibrous stalks and a single layer of endothelium. The capillary formation was poorly defined, and mitotic figures were frequently observed. Immunohistochemically, the endothelial cells were positive for factor VIII related antigen and vimentin, and many cells were positive for PCNA, not only in the solid proliferating area but also in the papillary proliferating area. This case represents IPEH with high proliferative activity.