Vascular Floor of Mouth Mass with Unanticipated Intracranial, Orbital, and Vertebral Associated Involvements

Abstract

We report on a case in which a blanching, unobtrusive oral growth proved to be a systemic threat. A blind, epileptic child presented with a bleeding oral floor mass of 4 weeks. Biopsy showed small, dilated vascular spaces with reactive fibroblasts. MRI indicated distribution of expansile lesions in the mandible, cranial base, and right orbit that had possibly contributed to the patient's years-long neurologic deficits. A subsequent bone scan indicated lesions in multiple axial bones. Histologic markers confirmed the presentation of a rare cystic vascular pathology. Cystic Angiomatosis is a disease of intraosseous vascular malformations with occasional visceral involvements. Oral and craniomaxillofacial cases are especially rare and presentations can involve neuropsychiatric deficits, sensory issues, and mucosal bleeding. While clinicians are often dismissive of intraoral bleeding because of the prevalence of periodontal disease, careful evaluation is nonetheless critical to rule out underlying diseases with a possibly significant systemic involvement.

Keywords: Blindness; Cystic angiomatosis; Epilepsy; Vascular neoplasm.

Fig. 1

Smooth, soft, immobile, and pink mass of the right floor of the mouth without overt surface changes

Fig. 2

Multicystic, gadolinium contrast-enhancing lesion occupying almost the entirety of the intracortical space in the right mandible

Fig. 3

Variously sized cystic masses in the right maxillary alveolus and sinus, orbital bones, and the cranial chamber with displacement of neuronal tissue