Diagnostic implications of oral intravascular papillary endothelial hyperplasia

Abstract

This study examined the clinical, histological, and immunohistochemical features as well as the differential diagnoses of oral intravascular papillary endothelial hyperplasia (IPEH) to aid clinicians and pathologists in its diagnosis. Clinical features of five oral IPEH cases were obtained from medical records, and all histopathological diagnoses were reviewed. Immunohistochemical reactions, including anti-CD-34, laminin, vimentin, estrogen receptor alpha, and Ki-67, were assessed. Microscopically, a reactive proliferation of vascular cells composed of small papillary structures with hypocellular and hyalinized cores arising in an organized thrombus was seen. CD-34, vimentin, and laminin staining were strongly positive, while estrogen receptor alpha was negative in all cases. A low percentage of cells were positive for Ki-67 in four of five lesions, but one case was strongly positive. A diagnosis of angiosarcoma was investigated and rejected. IPEH presents specific microscopic characteristics that along with clinical data lead to an accurate diagnosis. The general dentist, the first to participate in the diagnostic process, must share the responsibility for diagnosis with the pathologist, and they must work together to determine the correct diagnosis and management. Oral lesions of IPEH are uncommon. Their main significance is that they show a microscopic resemblance to angiosarcoma. Thus, clinicians should have more information regarding this benign entity. Finally, we suggest that in recurrent cases exhibiting strong immunolabeling of proliferative markers the possibility of angiosarcoma should be investigated.

Oral Intravascular Papillary Endothelial Hyperplasia Associated with an Organizing Thrombus: Case Report and Immunohistochemical Analysis

“…Differently from CD34 and CD31 immunomarkers, the CD105 immunostaining is useful in the differential diagnosis since it is overexpressed in angiosarcoma cells [3]. Vimentin, laminin, podoplanin, and type IV and type I collagen immunopositivity were also reported, highlighting the complexity of the stroma in these lesions [12, 13]. The current case showed CD34 positivity in the endothelial cells and low Ki-67 proliferation index (4%).…”

“…Moreover, the Ki-67, a cellular marker for proliferation, may help to predict the biological behavior of IPEH lesions [6]. Usually the Ki-67 index labelling is low (<10%), and, apparently, cases that show higher immunopositivity tend to recur more often [3, 13]. Moreover, for better characterizing of IPEH, several other endothelial cell markers were already used as CD34 (pan-endothelial marker), CD31 (platelet endothelial cell adhesion molecule-1), and CD105 (endoglin) [3, 12, 13].…”

“…Usually the Ki-67 index labelling is low (<10%), and, apparently, cases that show higher immunopositivity tend to recur more often [3, 13]. Moreover, for better characterizing of IPEH, several other endothelial cell markers were already used as CD34 (pan-endothelial marker), CD31 (platelet endothelial cell adhesion molecule-1), and CD105 (endoglin) [3, 12, 13]. Differently from CD34 and CD31 immunomarkers, the CD105 immunostaining is useful in the differential diagnosis since it is overexpressed in angiosarcoma cells [3].…”

Intravascular papillary endothelial hyperplasia of the internal auditory canal

“…Immunohistochemistry also aids in the diagnosis of IPEH. IPEH is strongly positive using CD‐34, laminin, and vimentin, which are all markers indicative of a vascular component to the lesion 7. In our case, we used CD‐31, which also binds to endothelial cells.…”

“…In our case, we used CD‐31, which also binds to endothelial cells. IPEH is negative for estrogen receptor‐α, whereas Ki‐67 staining may be positive in cases in which recurrence or high proliferative activity of the lesion is suspected 7…”