Capillary hemangioma: An occasional growth of attached gingiva
A 30-year-old female reported with a gradually increasing, painless swelling in the upper left posterior palatal region since childhood. There was history of frequent bleeding from the lesion, and difficulty in swallowing and speaking.\nExtra-oral examination including the lymph nodes was insignificant. Intra-oral examination revealed a 2×2.5 cm growth which was red in color with bluish hue and with slightly pale periphery, arising from the buccal attached gingiva of maxillary left first and second molar, which extended palatally []. The lesion appeared sessile imperceptibly with the papilla and attached gingiva. Although two surface ulcerations were noticed, probably due to trauma during mastication, the remaining entire surface was smooth with several visible small vessels. The growth was gently soft to palpate and showed blanching on application of pressure, and was pulsatile but not reducible []. Intra-oral periapical radiograph of the region exhibited a horizontal pattern of bone loss due to chronic periodontitis []. Carotid angiogram could not be possible because of under-privileged socio-economic status.\nA provisional diagnosis hemangioma was laid down due to clinical appearance and characteristics of the growth. Preoperative hematological examination revealed all findings within normal parameters. Widman's periodontal flap of maxillary left quadrant was carefully raised under local anesthesia (posterior superior alveolar block) and the growth was excised []. Bleeding spots were cauterized and intermittent sutures were given and periodontal dressing was applied. The excised growth [] was sent for histo-pathological examination (HPE) and patient was given necessary hygiene instructions for home care of wound. Satisfactory uneventful healing occurred and follow-up was done for two years to monitor any recurrence.\nThe excised soft tissue mass was subjected to routine processing and several sections were obtained. HPE of the sections obtained from the lesion showed numerous capillaries filled with RBC in a delicate fibrillar connective tissue which was predominantly full of proliferating endothelial cells. Few inflammatory cells were also evident in the stroma. The connective tissue component was covered by parakeratinized stratified squamous epithelium which showed ulceration at few places. Areas of ulceration were covered with fibrin meshwork and were infiltrated by RBCs and mixed inflammatory cells. Correlating the microscopic features with the clinical picture, HPE confirmed the diagnosis as “Capillary hemangioma” [Figures –].