RESUMO

A 55-year-old male patient with single and well-circumscribed nodule in the lower lip. Accurate diagnosis is based only on histopathological examination using hematoxylin and eosin and immunohistochemical approach, which a large, organized thrombus within the dilated lumen of a poorly demarcated vein, associated with papillary projections of endothelial proliferation occupying vascular spaces. The final diagnosis was intravascular papillary endothelial hyperplasia (IPEH) associated with a thrombus. Oral IPEH is rare and has historically been difficult to diagnose due to its resemblance to other oral lesions. However, the distinctive histological features of oral IPEH associated with a thrombus now allow for its diagnosis through hematoxylin and eosin staining alone, without the need for additional techniques. Therefore, it is crucial for pathologists to be familiar with these unique morphological features to accurately diagnose oral IPEH and differentiate it from more common benign, malignant, or reactive vascular lesions in the oral cavity.

RESUMO

Intravascular papillary endothelial hyperplasia (IPEH) is characterized by proliferation of endothelial cells usually occurring within a long-standing vascular malformation or tumor. IPEH usually affects neck, head and lower extremities, and few orbital and eyelid cases have been reported. We present a unique case, a 48-years-old man with a purple, elevated, multilobular conjunctival lesion of three-weeks duration that underwent an excisional biopsy. Pathological features revealed intravascular papillary endothelial hyperplasia (Masson's tumor).

Assuntos

RESUMO

Masson's tumor or intravascular papillary endothelial hyperplasia (IPEH) is considered a non-neoplastic lesion. It is probably an unusual exaggerated reorganization of a thrombus. IPEH may be present as a secondary lesion in hemangiomas. Symptomatic osseous hemangiomas are rare tumors. Few cases of clival and petrous bone hemangiomas have been described. None of them shows secondary IPEH. So far, there are only four reported cases of cranial bone IPEHs in the literature, two in the skull, one in the clivus and one in the petrous apex. The aim of this study is to report an additional case of osseous hemangioma with secondary IPEH of the petroclival region. We review the literature and describe the main clinical features of IPEHs and hemangiomas of the clivus and the petrous bone. Additionally, we report an unusual histological feature observed in our case of IPEH, the presence of psammoma body-like structures. This feature has been rarely mentioned previously in IPEH. We consider that IPEH should be included in the lesions that may present psammoma bodies to avoid misdiagnosing it as a tumor that commonly shows psammoma bodies, such as intraosseous meningioma or, less frequently, metastasis of thyroid or ovarian carcinoma.

Assuntos

RESUMO

La hiperplasia endotelial papilar intravascular (HEPI) es una lesiónbenigna muy poco común en la cavidad oral. Fue descrita por primera vez por Masson en 1923 como hemangioendotelioma vegetante intravascular; más adelante, se le dieron diferentes nombres como angiomatosis intravascular, seudoangiosarcoma de Masson y, por último, hiperplasia endotelial papilífera intravascular. Los hallazgos en bocason poco comunes, y cuando se presentan, generalmente es en labio.Se expone el caso clínico de un paciente de 78 años de edad con una lesión asintomática bilobular en encía, que refi ere una evolución lenta y progresiva de 10 años. Se emitió un diagnóstico clínico presuntivo degranuloma periférico de células gigantes y se procedió a realizar biopsiaescisional, así como su envío a estudio histopatológico para confirmar eldiagnóstico; se emitió el diagnóstico de HEPI y se confirmó por medio de inmunohistoquímica. Esta lesión puede ser fácilmente confundida con neoplasias malignas vasculares (angiosarcoma, sarcoma de Kaposi),tanto clínica como histopatológicamente. El objetivo de este trabajo es describir mediante un caso clínico la importancia de un correcto diagnóstico a través de una adecuada exploración clínica, así comouna observación microscópica a conciencia y la comunicación interdisciplinaria entre el cirujano maxilofacial y el patólogo bucal, para no confundir esta entidad benigna con otro tipo de patologías que requieren tratamientos más agresivos e invasivos, sin ser adecuados para la HEPI.

Intravascular papillary endothelial hyperplasia (IPEH) is a rarebenign lesion in the oral cavity. It was fi rst described by Massonin 1923 as intravascular vegetating hemangio endothelioma, andlater received diff erent names, like «intravascular angiomatosis¼,«Masson’s pseudoangiosarcoma¼ and «intravascular papillaryendothelial hyperplasia¼; fi ndings in the mouth are rare, and when present, they are generally in the lip. The clinical case presented is a78-year-old patient with a bilobular asymptomatic lesion in gingivawith a slow and progressive 10-year evolution. A presumptive clinicaldiagnosis of peripheral giant-cell granuloma was issued, followed byan excisional biopsy and histopathology study to confi rm the diagnosis;it had been correctly diagnosed as IPEH, which was confi rmed byimmuno histochemistry. This lesion can be easily confused with vascular malignancies (angiosarcoma, Kaposi sarcoma) both clinically andhistologically. The intention of this work is, through a clinical case,to describe the importance of a correct diagnosis by a proper clinical examination, detailed microscopic observation and interdisciplinary communication between the surgeon and the pathologist, in order toavoid a misdiagnosis of this benign entity with other pathologies tha trequire more aggressive and invasive treatments, inadequate for IPEH.

Assuntos