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Presented by William Westra, M.D. and prepared by Lynette S. Nichols, M.D.
Case 6: 72 year-old woman with a red nodule located on the ventral tongue
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Week 140: Case 6
72 year-old woman with a red nodule located on the ventral tongue/images/Lyn’s/w-6a.jpg
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Answer: Papillary endothelial hyperplasia
Histology: The surface squamous epithelium appears in-tact. Within the submucosa is a central area of organizing hematoma. At the periphery of the hematoma is an ingrowth of blood vessels with an exuberant proliferation of endothelial cells. In some areas, these vessels form slit-like spaces. In other areas, endothelial cells line central cores of fibrin and collagen to papillary projects. The lining endothelial cells are not cytologically atypical, and they do not form multilayered tufted structures. The endothelial natures of the cells is supported by strong staining with Factor VIII. Due to the fragmented nature of the specimen, it is difficult to determine whether the area of organizing blood and fibrin actually involves a blood vessel.
Discussion: Papillary endothelial hyperplasia (PEH) is a benign, nonneoplastic vascular lesion that is characterized by papillary fronds lined by proliferating endothelium. It is thought to represent a peculiar manifestation of an organizing thrombus. In its pure form it involves a dilated blood vessel; in its mixed form it involves some other pre-existing vascular lesion (e.g. hemangioma, vascular malformation, pyogenic granuloma or even a hematoma). Numerous cases have been reported in the oral cavity, the lip and tongue being the most commonly involved intraoral sites.
Its principle importance lies in the fact that it may be mistaken for angiosarcoma. Helpful clues in distinguishing PEH from angiosarcoma are its intimate association with a thrombus, relative confinement to a blood vessel without infiltration of surrounding tissues, and lack of pleomorphism and mitotic activity.Incorrect
Answer: Papillary endothelial hyperplasia
Histology: The surface squamous epithelium appears in-tact. Within the submucosa is a central area of organizing hematoma. At the periphery of the hematoma is an ingrowth of blood vessels with an exuberant proliferation of endothelial cells. In some areas, these vessels form slit-like spaces. In other areas, endothelial cells line central cores of fibrin and collagen to papillary projects. The lining endothelial cells are not cytologically atypical, and they do not form multilayered tufted structures. The endothelial natures of the cells is supported by strong staining with Factor VIII. Due to the fragmented nature of the specimen, it is difficult to determine whether the area of organizing blood and fibrin actually involves a blood vessel.
Discussion: Papillary endothelial hyperplasia (PEH) is a benign, nonneoplastic vascular lesion that is characterized by papillary fronds lined by proliferating endothelium. It is thought to represent a peculiar manifestation of an organizing thrombus. In its pure form it involves a dilated blood vessel; in its mixed form it involves some other pre-existing vascular lesion (e.g. hemangioma, vascular malformation, pyogenic granuloma or even a hematoma). Numerous cases have been reported in the oral cavity, the lip and tongue being the most commonly involved intraoral sites.
Its principle importance lies in the fact that it may be mistaken for angiosarcoma. Helpful clues in distinguishing PEH from angiosarcoma are its intimate association with a thrombus, relative confinement to a blood vessel without infiltration of surrounding tissues, and lack of pleomorphism and mitotic activity.
