HOME - Clinical cases - Oral pathology
 
 
04 December 2019

Angiomatous lesion, of progressive growth, on the dorsum of the tongue in an elderly patient

Authors: D. Migliari, N. Sugaya, M. Trieveiler.


Reported by his dentist, a 76-year-old patient turns to our observation and has noticed for about a month the appearance of a lesion on the back of the tongue. The clinical examination reveals the presence of a sessile exophytic neoformation, rounded, with well delimited margins, of vermilion red (fig. 1). The patient reports that the lesion has grown rapidly and is concerned that it may be a malignant disease. The medical anamnesis reveals a diagnosis of multiple myeloma dating back to about 18 months ago for which the patient was treated with unspecified chemoterapics, corticosteroids and antibiotics. At the moment, the patient only takes antihypertensive therapy.

DIAGNOSIS AND CARE
The clinical aspect suggested a lesion of a predominantly vascular nature. Equally important is the fact that the lesion presented a fibrous consistency on palpation and no signs of ischemia with digital compression were evident. Despite the absence of obvious local factors, and the absence of anamnestic data that could indicate a previous trauma, the differential diagnosis included traumatic hemangioma and pyogenic granuloma. The benignity of both injuries was reported to the patient with the aim of reassuring her. Subsequently, having obtained informed consent, the patient was subjected to an excisional biopsy operation. The technique used was the conventional one, which involves two incisions that meet to form a lozenge at the edge of the lesion (figs. 2a, b). This technique allows the connection of the surgical wound margins very efficiently. The tissue sample underwent a histopathological examination which showed a hyperkeratotic epithelium, with acanthosis, and an area of ​​ulceration. In the connective tissue there were lobular structures consisting of cells of endothelial origin, in which small vascular spaces were evident (fig. 3). 

The clinical aspect of the pyogenic granuloma can sometimes recall that of a senile capillary hemangioma (also known as "venous lake"), which is a type of lesion most common in the elderly, often located at the vermilion of the lower lip . In the venous lake there is no evidence of traumatic factors, while there may be some familiarity. The best procedure to make a distinction is to exert a compression on the lesion: the capillary hemangioma tends to ischemic and discolor, while in the pyogenic granuloma this effect does not occur.

In the case of pyogenic granuloma it is necessary to intervene surgically, preferentially using a conventional cold-blade technique, this because it is always necessary to proceed with the histological examination of the lesion. For hemangioma, on the other hand, the intervention is indicated only if the lesion is causing an aesthetic or (more rarely) functional problem. In order to treat capillary and cavernous eczema, it is preferable to use surgical lasers, which allow better bleeding control, rather than conventional excision. This intervention, however, must be carried out preferentially by the specialist, who has the knowledge of the differential diagnosis and the skill needed to perform the surgery.

  • Fig. 1:  Red vermilion exophytic lesion on the back of the tongue

    Fig. 1: Red vermilion exophytic lesion on the back of the tongue

  • Figs. 2a-2b: The incision from the fusiform design (a); check about 4 weeks after the intervention (b)

    Figs. 2a-2b: The incision from the fusiform design (a); check about 4 weeks after the intervention (b)

  • Fig 3. Histological examination shows a predominance of vascular tissue

    Fig 3. Histological examination shows a predominance of vascular tissue

Related articles

Oral pathology     06 November 2019

Multiple white lesions

Co-authors: F. Scotti, M. Mandaglio, S. Decani, E. Baruzzi

An 83-year-old female patient arrives in urgency complaining of noticeable exacerbation of the symptoms at the level of oral mucous. The patient, non-smoker...


Authors: M. Gobbo, G. Ottaviani, K. Rupel, M. Biasotto

A female patient was sent to the Medicine and Oral Pathology clinic of the Dental Clinic of Trieste for the evaluation of an intensely radiopaque foreign body...


Co-authors: F. Scotti, M. Mandaglio, S. Decani, E. Baruzzi, L. Moneghini

An 85-year-old patient comes to our attention complaining of the presence of a swelling of the right half-left, present for some time unspecified and gradually increased. The patient's medical...


Authors: G. Mergoni, I. Giovannacci, G. Giunta, G. Ghidini, M. Meleti, M. Manfredi, P. Vescovi

An 11-year-old patient  was sent to out observation by her pediatrician for a maxillary gingival lesion that had arisen about 2 months earlier and...


Odontogenic keratocyst (OKC), also known as keratoconus odontogenic tumor, is locally aggressive and frequently relapses, with most relapses occurring within 5 years of treatment. It originates...


Read more

Chronic periodontitis  (CP) accounts for 95% of PD caused by microorganism infection and aetiology with local irritation. Most CP patients are adults,...


It is widely known that the presence of high levels of plaque cause gingivitis. Powered toothbrushes are now generally regarded to be more efficacious than...


Maxillary third molar extraction is commonly performed in dental clinics. The traditional techniques is a combination of luxation and removal forces...


Inlay and overlay are a good and right choice in case of large carious and restorative defects. The introduction of CAD/CAM system gives the possibilities to...


38-year-old male patient with negative medical history, who comes for a visit many years after the last dental check-up. He reports difficulty in removing food...


 
 
 
 

Newsletter

 
 
 
 

Most popular

 
 

Events