Intraoral epithelioid hemangioendothelioma: an intermediate vascular tumor- a case report

Abstract

Vascular neoplasms, other than benign are characterized as intermediate or malignant. They are often enshrouded in controversy, because the same neoplasm could show variability in biologic behavior that may not be correlated with microscopic features. The intermediate grade vascular neoplasm is named as epithelioid hemangioendothelioma (EHE). Epithelioid hemangioendothelioma of the oral cavity has been infrequently reported. To the best of our knowledge, the review of the English literature revealed a total of 30 cases of intraoral EHE reported till today. We report such a rare case in a 20 year old male, presented with a growth in lower anterior lingual gingiva since five months before the diagnosis with a history of similar swelling, twice in the same area. The differential diagnosis and brief review of literature is also discussed in the current article.

Keywords: Epithelioid; Hemangioendothelioma; Hemangiosarcoma.

Figure 1

Asymptomatic, erythematous mass on the lower lingual gingiva in the midline

Figure 2

IOPA and Occlusal radiographs showing saucer like bony erosion of underlying alveolar bone in the midline extending bilaterally up to canines.

Figure 3

Photomicrograph showing sub-mucosal nodule of tumor mass arranged in clusters/nests of cells close to overlying oral epithelium (hematoxylin and eosin staining × 100).

Figure 4

Photomicrograph showing hyperchromatic to vesicular nuclei close to small and medium sized blood vessels in a myxoid to scanty collagenised stroma (hematoxylin and eosin staining × 250)

Figure 5

Photomicrograph showing epithelioid cells with intracytoplasmic lumen formation and few mitotic figures (hematoxylin and eosin staining × 250)

Figure 6

Photomicrograph showing epithelioid tumor cells having vacuolated cytoplasm with lumen and also shows nuclear and cellular pleomorphism (hematoxylin and eosin staining × 400).

Figure 7

Photomicrograph showing dense reticulin network surrounding tumor cells, confirming the tumor origin from endothelial cell (reticulin staining X 250).