Oral Hemangiomas Workup

Updated: Mar 21, 2018
  • Author: Steven Brett Sloan, MD; Chief Editor: William D James, MD  more...
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Workup

Laboratory Studies

Usually, no laboratory studies are useful in the diagnosis or management of oral hemangiomas.

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Imaging Studies

Workup of oral hemangiomas requires some form of imaging to determine their extent and flow characteristics.

Angiography is considered the most definitive of the studies, although the angiographic appearance of intraosseous lesions is less well defined than that of soft tissue lesions. [17]

Ultrasonography can be used to determine that a lesion is angiomatous in nature (ie, hemangioma, lymphangioma), but it cannot be used to differentiate a hemangioma from a lymphangioma.

Contrast-enhanced MRI can be used to differentiate a hemangioma from a lymphangioma in the oral cavity. [23] MRI appears to be highly reliable for lesions of either soft tissue or bone.

On plain films or panoramic radiographs, a central vascular malformation of the bone usually has a honeycombed appearance or cystic radiolucencies. [17] Intraosseous vascular malformations show a nonspecific reticulated or honeycombed pattern that is well demarcated from normal bone. A sunburst effect, created by spicules radiating from the center, is often present.

CT scans often show an expansile process with a high-density amorphous mass that may be suggestive of fibrous dysplasia.

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Procedures

Procedures other than a clinical history or examination, including aspiration of intraosseous lesions, that are used to diagnose oral hemangiomas readily produce frank blood. Performing a biopsy of oral hemangiomas can be potentially dangerous.

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Histologic Findings

Histopathologically, vasoformative tumors share many similar microscopic features, and overlap between hemangiomas and vascular malformations exists. Hemangiomas are subclassified as capillary or cavernous, depending on the size of the vascular channels. Vascular malformations, as true structural anomalies, exhibit a normal rate of endothelial cell turnover. Spaces are lined by endothelium without muscular support. An increase in normal- and abnormal appearing blood vessels occurs. The endothelial cells of early lesions may be plump, obscuring the lumen of the capillaries. Phleboliths may develop as a result of dystrophic calcification in thrombi. Intimal thickening or diverse arteriovenous connections can sometimes be seen in serial sections. Johann et al showed that histological diagnosis alone is not sufficient to correct diagnoses of oral hemangioma. Moreover, immunohistochemistry to GLUT1 is a useful and easy diagnostic method that may be used to avoid such misdiagnosis. [24]

Salient histopathologic findings of vasoformative tumors that distinguish them are described below.

Hemangioma (proliferative phase) histopathologic findings are as follows:

  • Endothelial cell hyperplasia forming syncytial masses

  • Thickened (multilaminated) endothelial basement membrane

  • Ready incorporation of tritiated thymidine in endothelial cells

  • Presence of large numbers of mast cells

Hemangioma (involuting phase) histopathologic findings are as follows:

  • Less mitotic activity

  • Little or no uptake of tritiated thymidine in endothelial cells

  • Foci of fibrofatty infiltration

  • Normal mast cell counts

Vascular malformation histopathologic findings are as follows:

  • No endothelial cell proliferation

  • Contain large vascular channels lined by endothelium

  • Unilamellar basement membrane

  • Does not incorporate tritiated thymidine in endothelial cells

  • Normal mast cell counts

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