Epithelioid Haemangioendothelioma of the mandibular gingiva: case report and literature review

Abstract

HighlightsThis paper demonstrates that oral EHE is an unpredictable lesion that seems to behave in a relatively benign fashion. This is in contrast with non-oral EHE where up to one third of cases may metastasize.Because of the propensity to recur locally after excision and curettage, a wide local excision with close clinical follow has been suggested in the literature as the treatment of choice for oral lesions.However, the lack of metastases from oral lesions, the small size, mandibular site and bland histology in this case suggests that a limited soft tissue excision and bone curettage, with long term follow-up would be appropriate for similar gingival lesions in future.

Metastatic cutaneous epithelioid hemangioendothelioma involving right atrium - a case report

“…[7,9,10] We find our case to be peculiar because it involved metastasis from soft tissue to the lungs, pericardium and right atrium, we did not find other case reports in English literature of metastasis of EHE into the heart.The outcome of EHE varies depending on affected sites; solitary and skin lesions appear relatively slow-growing, whereas multicentric lesions or those with histological atypia, and lesions form sites such as bone or lungs may metastasize and carry a fatal outcome. [18] Our patient had a very slow growing swelling over a long period of time, probably unat-tended the lesions transformed to a more aggressive behavior. Poor prognostic indicators include low weight, anemia, pulmonary symptoms, pleural hemorrhagic effusions and hemoptysis.…”

Metastatic epithelioid haemangioendothelioma masquerading as periodontal pathosis: a case report

“…Wide local excision is often favoured, 2,6,9 but the lesions can lend themselves to observation. 5 The required extent of oncologically-clear margins to limit locoregional recurrence is unknown. Wide local excision can have considerable local morbidity, which our patient was unwilling to accept.…”

Intraosseous epithelioid haemangioendothelioma of the mandible

“…In contrast, there are only 30 reported cases of EHE in the oral cavity. [7] The most commonly reported intraoral site for EHE development is the gingiva or alveolar mucosa, [4] with tumor diameters ranging from 1.5 to 4.5 cm, and affecting men and women at a ratio of 1:2.5. [8] Patients were usually referred based on the presence of a solitary, red-purplish, asymptomatic mass on the alveolar gingiva, buccal mucosa, tongue, palate, lip, maxilla, or mandible.…”

“…The literature indicates that 29.6% (8/27 cases) of intra-oral EHEs locally recur without developing distant metastases. [4] Thus, cases with abundant mitoses and histological atypia should be treated carefully, as it is impossible to predict the true recurrent and metastatic potential of intraoral EHE. [17] Furthermore, treatment of this disease is complicated by the lack of clear terminology and standard diagnostic criteria, as well as its anatomic site- and patient age-dependent biological behavior.…”

“…[2,3] Additionally, there are only approximately 30 reported cases of this tumor type in the oral cavity, with most cases involving the gingiva of the mandible or maxilla. [4] Intraosseous EHE of the mandible is extremely rare, with only 5 cases reported in the literature. Thus, based on its low incidence and histological similarity to other solid tumors, it is difficult to precisely diagnose EHE.…”