Intravascular papillary endothelial hyperplasia of the mouth: report of six cases and literature review

Abstract

OBJECTIVE: Oral intravascular papillary endothelial hyperplasia (IPEH) is an uncommon, reactive vascular lesion with no specific clinical featureS. Microscopically two subtypes have been described: a pure and a mixed form. The importance of IPEH is in its resemblance to angiosarcoma. The aim of this study was to evaluate both the prevalence of IPEH in a consecutive series of oral vascular malformations and the clinico‐pathological features. MATERIALS AND METHODS: Histological sections of 103 consecutive cases filed as vascular malformations were reviewed for histopathological criteria of IPEH.RESULTS AND CONCLUSION: We found six cases of oral IPEH, of which three were diagnosed previously. Five of these cases were in males, and the mean age was 58 yearS. It was usually described as a blue or reddish nodule. The lower lip mucosa was the most common site followed by the tongue and the upper lip. Histologically, thrombi were always present and five out of the six lesions appeared in a mixed form, while only one was in a pure form. Three cases were diagnosed at an early stage and in the other three, the lesions were well‐established. In this series, IPEH associated with vascular malformation was more common than reported in previous studieS. Lesions at early stages, especially in the mixed form, may be unnoticed.

Intravascular Papillary Endothelial Hyperplasia: Report of 4 cases with immunohistochemical findings

“…Intravascular papillary endothelial hyperplasia (IPEH) is a relatively uncommon benign and non-neoplastic vascular lesion (1)(2)(3)(4). It was first described by Masson in 1923, as an endothelial proliferation with associated thrombosis and fibrin deposition, leading to obliteration of the vascular lumen (1)(2)(3)(4).…”

“…It was first described by Masson in 1923, as an endothelial proliferation with associated thrombosis and fibrin deposition, leading to obliteration of the vascular lumen (1)(2)(3)(4). It is histologically characterized by the presence of endothelium-lined papillary structures composed by a single layer of plump cells around a fibrin core that sometimes forms irregular anastomosing clefts, simulating an angiosarcoma (5)(6)(7)(8).…”

Intravascular Papillary Endothelial Hyperplasia: A Rare Vascular Lesion Affecting Submandibular and Sublingual Region

“…However, the pathogenesis remains unknown. IPEH is now accepted as a reactive proliferation of endothelial cells arising in an organizing thrombus, possibly related to trauma, which justifies the presence of these lesions on lip cheek or tongue, as these are the most commonly affected by trauma in oral region [3] [4]. The patient was unaware of any recent trauma to the submandibular and sublingual region, but thrombosis which IPEH maybe arise from were observed under microscope.…”

“…IPEH should be distinguished from hemangioma, vascular anomalies or mucocele when it affects the head-neck region. A histological review of 103 consecutive cases of vascular malformations of the oral cavity showed 6 cases of IPEH [3]. The surgeon and pathologist of local community hospital diagnosed the lesion as venous malformations (VMs) because of the atypical microscopic features and lack of knowledge of IPEH.…”

Diagnostic implications of oral intravascular papillary endothelial hyperplasia

“…[1][2][3][4][5][6][7][8][9] It typically presents (1) as an isolated, thrombosed blood vessel; (2) in association with a preexisting pyogenic granuloma, hemangioma, or other vascular malformation; or (3) from a hematoma. 7,10 Although its etiology remains uncertain, it has recently been suggested that this lesion represents an unusual form of organizing thrombus with reactive proliferation of endothelial cells in response to infl ammation and stasis.…”