Case Report History :26 year old caucasian male presented complaining of an intra oral swelling involving the gum margin of the upper left jaw. He gave.
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Presentation on theme: "Case Report History :26 year old caucasian male presented complaining of an intra oral swelling involving the gum margin of the upper left jaw. He gave."— Presentation transcript:
Case Report History :26 year old caucasian male presented complaining of an intra oral swelling involving the gum margin of the upper left jaw. He gave a 4 month history with no obvious aetiology. Medical history was unremarkable. Examination : Erythematous mass 1.5x1.0 cm involving he gingivae in the upper left canine nd premolar area (figure 1). Management Due to malignant potential of lesion following histological report radical excision was undertaken. Haematology and biochemistry preoperatively were all within normal range. Histopathology (figure 2) demonstrated thickened stratified squamous epithelium with epithelioid cells, some forming tubular structures. There was a positive reaction for epithelial markers. Cells show pleomorphism, large nuclei, prominent nucleoli and occasional mitotic figures. There are vascular channels at the periphery, some of which extend to the deep margins of the biopsy. In view of definitive diagnosis and potentiality for widespread metastasis chest X ray, ultrasound scan of liver and liver biochemistry were undertaken and demonstrated no abnormality. Long term follow up was arranged. The appearance here at 6 months post surgery (figure 3) demonstrates potential problems with identifying recurrence as opposed to common inflammatory conditions. eg periodontal disease. References 1. Weiss S.W., Enzinger F.M. Epithelioid Haemangioendothelioma: vascular tumours of intermediate malignancy. In: Soft tissue tumours. 4 th Edition. St Louis: CV Mosby; 1995. 2. Weiss S.W., Enzinger F.M. Epithelioid Haemangioendothelioma, a vascular tumor often mistaken for a carcinoma. Cancer 50:970, 1982. 3. Orsini G., Fiorini M., Rubini C. et al. Epithelioid Haemangioendothelioma of the Oral Cavity: Report of Case. J Oral Maxillofac Surg 59;334-337. 2001. 4. de Araujo V.C., Marcucci G., Sesso A. et al. Epithelioid Haemangioendothelioma of the gingiva: Case report and ultrastructural study. Oral Surg, Oral Med, Oral Pathol. 1987;63:472-7. 5. Marrogi A.J., El-Mofty S.K., Waldron C. Epithelioid Haemangioendothelioma of the oral cavity: Report of Two cases and review of the literature. J Oral Maxillofac Surg. 49, 633-638. 1991. 6. Pigidas N., Mc Dermott P. Epithelioid Haemangioendothelioma of the parotid salivary gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89:730-8. Epithelioid Haemangioendothelioma Arising in the Oral Cavity Pilcher R., Johnson A., Hamlyn J.F., Davidson M.J.C. Department of Oral and Maxillofacial Surgery, Taunton and Somerset Hospital. UK www.tauntonmaxfax.org Epithelioid haemangioendothelioma (EHE) is a vascular neoplasm of soft tissue characterised by a proliferation of endothelial cells with an epithelial morphology 1. A rare case involving the gingival epithelium is presented. Investigations Radiographic examination: no bony abnormality in the area with no evidence of periodontal disease and no periapical pathology. Incisional biopsy:Histopathology reported a well circumscribed ulcerated lesion with cells staining positively for an endothelial marker. There was considerable nuclear pleomorphism and some mitotic activity. A lesion of vascular origin of uncertain malignant potential was described. Discussion Haemangioendothelioma is a soft tissue vascular tumour with histological and clinical features intermediate between those of a haemangioma and angiosarcoma. It was first applied by Weiss and Enzinge in 1982 2 to define a special entity among vascular tumours. It occurs during adulthood and typically as here as a well-delimited mass. Up to 2001 only 8 cases had been reported in the oral cavity 3 and of these only 3 had involved the gingivae 4. Marrogi et al in 1991 reported treatment of five cases of the oral cavity by surgery 5. Pigidas et al recommended wide local excision as the treatment of choice and as being probably curative in the majority of cases. They considered radiotherapy alone to be hardly ever effective because of the slow growth of the tumour cells and reported several chemotherapeutic regimens to have been tried but treatment as not curative 6. Figure 1: EHE of the gingivae at initial presentation. Figure 2: Histopathology of the excised lesion which was reported as an EHE of uncertain malignant potential. Figure 3: Surgical area 6 months post operatively.