|Year : 2015 | Volume
| Issue : 3 | Page : 497-499
Oral hemangioma or vascular malformation: Different entities!
Ujwala Rohan Newadkar
Department of Oral Medicine and Radiology, ACPM Dental College, Dhule, Maharashtra, India
|Date of Submission||26-Jan-2015|
|Date of Acceptance||02-Nov-2015|
|Date of Web Publication||25-Nov-2015|
Ujwala Rohan Newadkar
Department of Oral Medicine and Radiology, ACPM Dental College, Dhule - 424 003, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The confusing and often misleading terminology used to define oral vascular tumescences along with the generic use of the term hemangioma has led to inappropriate grouping of a number of entities that are known to be biologically distinct. In many cases, the differential diagnosis between hemangioma and vascular malformation cannot be made on the basis of routine analysis. Hemangiomas were differentiated from vascular malformations by their clinical appearance, histopathologic features, and biologic behavior. However, the term hemangioma is still overapplied by clinicians and pathologists without regard to etiology or clinical behavior. Thus, a critical approach toward vascular tumescence represents the first step to reach a correct diagnosis, understand the disease pathogenesis, and provide better therapy. Here, a case report of arteriovenous malformation in the oral cavity is presented.
Keywords: Arteriovenous malformation, biologic behavior, differential diagnosis, hemangioma, vascular malformation
|How to cite this article:|
Newadkar UR. Oral hemangioma or vascular malformation: Different entities!. J Indian Acad Oral Med Radiol 2015;27:497-9
| Introduction|| |
Unlike hemangiomas, vascular malformations are not tumors. Rather, they are true congenital vascular anomalies that may not be clinically observed until late infancy or early childhood. The few studies on benign oral vascular lesions frequently do not distinguish between oral hemangioma and vascular malformation, or regard oral vascular malformation as a histological type of hemangioma, known as arteriovenous hemangioma.  Hemangiomas are classified as capillary and cavernous on the basis of the vascularization system. Capillary hemangiomas consist of small capillary bodies that organize lobularly. Cavernous hemangiomas consist of wide and dilated vessels and can reach to large sizes. Hemangiomas can be encountered intraorally on lips, tongue, anterior gingival, and buccal mucosa. The purpose of this article is to report a case of arteriovenous malformation on the buccal mucosa and highlight the difference between oral hemangioma and vascular malformation as well as its diagnostic dilemma.
| Case Report|| |
A 23-year-old male came to the department for routine dental check-up. Intraoral examination revealed the presence of a vascular lesion situated on the left buccal mucosa in front of the maxillary premolar region. Patient was completely unaware of this. It was exophytic and irregularly spherical in shape, painless, about 1.5 cm in diameter, covered by blue-dark purple mucosa, with no break or ulceration [Figure 1]. There were no signs of blanching after application of finger pressure and no pulsations were obtained from the lesion. There was no clinically detectable lymphadenopathy. A clinical diagnosis of vascular tumor was established, which was compatible with both vascular malformation and vascular neoplasm (hemangioma). Doppler ultrasonography of the lesion was done [Figure 2]. Laboratory investigations, complete blood count, and routine blood chemistry were within normal ranges. The excised vascular lesion was sent to the pathology department. The histopathologic findings revealed an arteriovenous malformation [Figure 3]. The post-treatment follow-up was satisfactory [Figure 4].
|Figure 2: Doppler ultrasonography revealing the well vascularized lesion|
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| Discussion|| |
Benign vascular lesions are a consequence of blood vessel abnormalities or endothelial cell proliferation. The diagnosis and the classification of the vascular malformations play an important role in the treatment plan of the lesions [Table 1] and [Table 2].  Mulliken and Glowacki proposed a terminology for classifying these lesions based on clinical and microscopic features.  This system broadly classifies vascular lesions into hemangiomas and vascular malformations. The hemangioma is the true vascular tumor that results from a neoplastic overgrowth of normal vascular tissue. The hemangioma grows by endothelial proliferation. Unlike hemangiomas, vascular malformations result from abnormal vascular or lymphatic vessel morphogenesis and they are not as a result of abnormal endothelial growth. Hemangiomas are usually present at birth and can be diagnosed by 1 year, whereas vascular malformations are present at birth but often not diagnosed until the second decade of life. Hemangiomas show rapid growth until 6-8 months and involute by 5-9 years of age. Vascular malformations show slow growth throughout life with increase in response to infection, trauma, or hormonal fluctuation and they do not involute.  Oral vascular malformation is characterized by hypocellularity and vascular channels lined by flat mature endothelium. The important signs for the diagnosis of cavernous hemangiomas are bidigital palpation of the region and detection of disappearance of the blood on finger pressure and appearance of blood after removal of finger pressure. Furthermore, if the lesion has an arterial origin, pulse can be obtained by finger pressure. In ultrasound, color Doppler sonography has been developed to identify vasculatures and to enable evaluation of the blood flow, velocity, and vessel resistance together with surrounding morphology. It can be used for detecting the course of the facial artery and for detecting hemangiomas.  The treatment for benign vascular lesions include surgical excision with blade or laser, cryosurgery, injection of corticosteroids or sclerosant (sodium tetradecyl), radiotherapy, and embolization with steel coil, gel foam, silicone beads, or cyanoacrylate. Whether they should be followed up or treated depends on the patient's age and site and size of the lesion. These treatment modalities mentioned above have notable disadvantages including excessive bleeding, fibrosis, scarring, cosmetic and functional deficiency due to the long-term effect of steroid and radiation. However, surgical excision and cryosurgery are effective treatments for small lesions and superficial ones. The technique of circumferential (intratumoral) ligation takes advantage of the easy accessibility of the feeder vessels. ,, However, since oral hemangioma is a neoplasm and oral vascular malformation is a disturbance of development, the distinction between these two entities is important for the knowledge of the clinical behavior and management of these illnesses. 
|Table 1: Current classification of hemangioma and vascular malformations|
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|Table 2: Simplifi ed diagnostic approach to a congenital vascular lesion|
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Declaration of patient consent
The author certifies that she has obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]