A Solitary Phlebolith in the Buccal Mucosa: Report of a Rare Entity and Clinicopathologic Correlation

Abstract

Pathological conditions can give rise to calcifications within oral mucosa representing either a local or systemic disturbance. Inflammation, trauma, debris acting as nidus and vascular lesions have been attributed as principal causes for occurrence of calcifications within the oral mucosa. Occurrence of multiple calcified thrombi (phleboliths) is considered pathognomonic for hemangiomas and vascular malformations in the oral and maxillofacial region. Isolated occurrence of phlebolith in oral mucosa though very rare, especially without any underlying vascular lesions, can be diagnostically challenging. Either a traumatic association at that site or a hemangioma of childhood that has regressed once the individual became an adult are the possible explanations suggested for the occurrence of these unique solitary phleboliths. Histologically, an "onion-ring"-like concentric lamellar fibrosis around a central core with varying amounts of calcifications and presence of minute vascular channels within or around calcified lamellae is characteristic for phlebolith. There is a high propensity for misdiagnosing solitary phlebolith located in sites like the buccal mucosa where various other pathologic soft-tissue calcifications, such as sialoliths, calcified lymph nodes, traumatic myositis ossificans, etc. can occur and they too appear radiopaque in radiographs. Besides, the absence of any associated underlying vascular lesion adds to the misperception. In such cases, histopathological examination with routine hematoxylin and eosin staining alone may not be sufficient to determine the accurate diagnosis. Allied clinical history and immunohistochemistry can aid to arrive at the final diagnosis. phlebolith in the right buccal mucosa of a healthy 49-year-old male patient and discuss its differential diagnosis with emphasis on histological presentation.

Incidental-imaging finding in the practice of oral diagnosis/oral medicine. A case report: Phleboliths in the maxillofacial region with literature review

“…[2,4,5] Occurrence of multiple calcified thrombi (phleboliths) is considered pathognomonic for hemangiomas and vascular malformations in the oral and maxillofacial region. [6,7] However, they may be the only remaining sign of a childhood vascular lesion encountered in adults and are more distinctive of low-flow vascular abnormalities. [3] Vascular anomalies usually comprise two distinct clinical and histopathological conditions: Hemangioma and vascular malformations.…”

“…The replication of this process conducts to the growth of the phlebolith, which may eventually cause symptoms in cases of constant blood stasis as in vascular malformations. [3,[6][7][8] Differential diagnosis of phleboliths in the head and neck area includes sialoliths, tonsillolihts, atherosclerotic plaques in the carotid artery, healed acne lesions, calcified lymph nodes, cysticercosis, and military skin osteomas. [2][3][4][5] Studies about hemangiomas and venous abnormalities connecting imaging methods have been reported in the literature intending to improve the diagnosis of these changes and the presence of phleboliths.…”

“…[2][3][4][5] Studies about hemangiomas and venous abnormalities connecting imaging methods have been reported in the literature intending to improve the diagnosis of these changes and the presence of phleboliths. [1] Previous cases reported in the literature, during the past 15 years, have showed the presence of these calcified bodies in different vascular anomalies in the maxillofacial region [ Table 1] [2][3][4][5][6][7][8][9][10] Plain X-rays represent a valuable diagnostic tool in diagnosing phleboliths within hemangiomas or vascular malformations because of the characteristic aspect of the calcified bodies. Radiographically, they appear as spherical and oval laminated forms that have either a radiolucent or a radiopaque center, and repetition of this calcification produces an onionlike appearance or concentric rings.…”

A case of dystrophic calcification in the masseter muscle

“…Pathologic soft tissue calcification of the cheek is an uncommon condition. There are many different types of calcifications, which includes dystrophic calcification, metastatic calcification, phleboliths, myositis ossificans, calcifications within lymph nodes, and calcified cutaneous aces, making differential diagnosis difficult [ 1 ]. In order to manage these lesions, they need to be distinguished from others that occur at the same area.…”

“…Precise examination and selection of appropriate imaging, such as plain radiographs, ultrasonography, computed tomography (CT) with contrast, and magnetic resonance imaging (MRI), are important to aid in differentiation. Histological evaluation is also essential to arrive at a final diagnosis [ 1 ].…”