Hemangiolymphangioama of buccal mucosa: Report of a rare case and review of literature on treatment aspect
An 18-year-old male patient, reported to Department of Oral and Maxillofacial Surgery, Trivandrum, Kerala, India, in May 2011, with the complaint of reddish swelling over left side of the upper lip with occasional bleeding while brushing since last 3-4 years. Patient noticed swelling over the left side of upper lip region 3-4 years back. Patient had repeated episodes of bleeding while brushing teeth or on mechanical trauma to the lesion. Patient visited private hospital, where he was kept on vitamin tablets and no other medications as history suggested by patient. The swelling was initially small papular which increased slowly to a size of 2×1 cm approximately in greatest dimension in last 2 years, after that there was no further change in swelling. At the time of reporting patient was having complaint of occasional bleeding from the lesion. Past medical and family history was non-contributory. Local examination revealed reddish multiple papular lesion over left side of buccal mucosa extending from 1cm behind the left corner of mouth in relation to 24, 25 of size approximately 2×1 cm []. There was no ulceration. On palpation the lesion was soft in consistency, non-tender, with smooth borders and was pulsatile in nature. There was no obvious increase in temperature of lesion. No obvious feeder vessel was identified. No obvious bleeding was identified on palpation of lesion. There was no associated lymphadenopathy. Provisional diagnosis of hemangioma left buccal mucosa was made. To rule out intracranial and bony involvement CT head and orthopantomogram (OPG) was taken, subsequently no abnormalities has been detected [Figures and ]. Excisional biopsy carried out under local anesthesia in proper aseptic conditions. Intraoperatively no obvious feeder vessel was identified. Mild to moderate bleeding was encountered and was managed by cauterization. Wide complete excision was done and surgical site was closed primarily. Gross specimen was soft in consistency and reddish in color and approximately of size 1.5×1 cm []. Specimen was sent for histopathological examination. Hematoxyline and eosine stain section shows hyperplastic stratified squamous epithelium which is extensively proliferating in to underlying moderately collagenous connective tissue stroma. There are numerous endothelail line vascular spaces through the stroma and extending in to submucosa. Intermixed with large vascular channels dilated lumphatic vessels also seen. Endothelial cells proliferation and forming vascular channels were also evident. There is minimal inflammatory infiltrate []. Histopathologically diagnosis of hemangiolymphangioma was made. Patient is on continuous follow-up no recurrence was noted till date.