Central Hemangioma

Central​ ​Hemangioma By​ ​Catherine​ ​DiGregorio Oral​ ​Pathology​ ​2017

Overview

A​ ​central​ ​hemangioma​ ​is​ ​a​ ​vascular​ ​lesion​ ​found​ ​within​ ​the​ ​bone.​ ​​ ​It​ ​is​ ​considered​ ​a​ ​rare condition.​ ​​ ​They​ ​are​ ​often​ ​difficult​ ​to​ ​diagnose.​ ​Often​ ​asymptomatic,​ ​many​ ​people​ ​only​ ​come​ ​in once​ ​swelling​ ​caused​ ​pain​ ​or​ ​discomfort​ ​or​ ​they​ ​are​ ​detected​ ​during​ ​a​ ​routine​ ​dental​ ​visit.​ ​Central hemangiomas​ ​can​ ​be​ ​difficult​ ​to​ ​treat,​ ​due​ ​to​ ​vascular​ ​nature​ ​of​ ​the​ ​lesion.​ ​Extractions​ ​in​ ​this areas​ ​can​ ​be​ ​problematic.​ ​Both​ ​clinical​ ​and​ ​radiographic​ ​evidence​ ​are​ ​necessary​ ​to​ ​diagnose​ ​this lesion,​ ​but​ ​diagnosis​ ​can​ ​be​ ​difficult​ ​and​ ​​ ​a​ ​biopsy​ ​can​ ​also​ ​be​ ​problematic.​ ​Hemorrhaging​ ​is​ ​a possibility​ ​if​ ​precautions​ ​are​ ​not​ ​taken. Etiology The​ ​etiology​ ​of​ ​the​ ​central​ ​hemangioma​ ​is​ ​unknown.

Clinical​ ​Presentation Clinical​ ​presentation​ ​of​ ​a​ ​central​ ​hemangioma​ ​could​ ​be​ ​a​ ​bluish​ ​mass,​ ​with​ ​or​ ​without​ ​pulsation. Mobile​ ​teeth​ ​may​ ​be​ ​present​ ​in​ ​this​ ​area​ ​as​ ​well.​ ​This​ ​area​ ​could​ ​also​ ​discharge​ ​blood. Demographic Although​ ​the​ ​central​ ​hemangioma​ ​is​ ​quite​ ​rare,​ ​studies​ ​show​ ​that​ ​it​ ​mainly​ ​occurs​ ​in​ ​women​ ​in​ ​a 2:1​ ​ratio.​ ​Occurrence​ ​is​ ​usually​ ​in​ ​the​ ​second​ ​decade​ ​of​ ​life.​ ​Central​ ​hemangiomas​ ​are​ ​found​ ​to occur​ ​more​ ​in​ ​Caucasians. Biopsy​ ​/​ ​Histology​ ​/​ ​Radiographs Biopsy​ ​of​ ​a​ ​central​ ​hemangioma​ ​can​ ​be​ ​hazardous​ ​or​ ​fatal​ ​due​ ​to​ ​the​ ​vascular​ ​nature​ ​of​ ​the lesion.

Histologically​ ​endothelial​ ​cells​ ​proliferate​ ​and​ ​form​ ​a​ ​pattern​ ​of​ ​vascular​ ​space.​ ​Thin​ ​wall​ ​spaces are​ ​lined​ ​with​ ​single​ ​layers​ ​of​ ​endothelial​ ​cells​ ​between​ ​bony​ ​trabeculae.​ ​The​ ​central hemangioma​ ​has​ ​three​ ​stages.​ ​The​ ​early​ ​stage​ ​is​ ​highly​ ​vascular.​ ​The​ ​intermediate​ ​stage​ ​will exhibit​ ​some​ ​blood​ ​clotting​ ​and​ ​the​ ​terminal​ ​stage​ ​has​ ​various​ ​degrees​ ​of​ ​ossification.

Radiographically​ ​the​ ​central​ ​hemangioma​ ​can​ ​present​ ​as​ ​many​ ​other​ ​intrabony​ ​lesions. Radiographically​ ​the​ ​central​ ​hemangioma​ ​presents​ ​as​ ​a​ ​multilocular​ ​radiolucency​ ​with​ ​fine trabeculation.

Differential​ ​Diagnosis A​ ​central​ ​hemangioma​ ​can​ ​be​ ​mistaken​ ​as​ ​many​ ​different​ ​other​ ​lesions.​ ​A​ ​differential​ ​diagnosis may​ ​include​ ​an​ ​ameloblastoma,​ ​giant​ ​cell​ ​lesion,​ ​myoma,​ ​dentigerous​ ​cyst,​ ​fibrous​ ​dysplasia, osteosarcoma,​ ​aneurysmal​ ​bone​ ​cyst,​ ​​ ​residual​ ​cyst,​ ​and​ ​granuloma. Treatment There​ ​are​ ​various​ ​treatment​ ​options​ ​for​ ​a​ ​central​ ​hemangioma.​ ​Some​ ​treatments​ ​include​ ​non invasive​ ​radiotherapy​ ​for​ ​lesions​ ​that​ ​are​ ​not​ ​accessible.​ ​Another​ ​treatment​ ​is​ ​intralesional injection​ ​of​ ​sclerosing​ ​agents​ ​.​ ​An​ ​injection​ ​can​ ​be​ ​administered​ ​into​ ​the​ ​lesion​ ​​ ​of​ ​boiling​ ​water, sodium​ ​morrhuate​ ​or​ ​sodium​ ​tetradecyl​ ​sulfate.​ ​These​ ​injections​ ​are​ ​usually​ ​used​ ​in​ ​extensive lesions.​ ​The​ ​agents​ ​work​ ​as​ ​a​ ​tissue​ ​irritant​ ​and​ ​thrombogenic​ ​agents,​ ​but​ ​do​ ​not​ ​work​ ​on​ ​osseous lesions.​ ​​Embolization​ ​of​ ​major​ ​vessels​ ​supplying​ ​blood​ ​to​ ​the​ ​hemangioma​ ​is​ ​an​ ​used​ ​when patient​ ​is​ ​not​ ​a​ ​good​ ​candidate​ ​for​ ​surgery.​ ​Curettage​ ​of​ ​the​ ​lesion​ ​along​ ​with​ ​radiation​ ​is suggested​ ​to​ ​be​ ​the​ ​best​ ​treatment​ ​for​ ​central​ ​hemangiomas.​ ​During​ ​surgery​ ​blood​ ​loss​ ​is​ ​to​ ​be expected.​ ​Curettage​ ​of​ ​the​ ​lesion​ ​is​ ​usually​ ​followed​ ​by​ ​bone​ ​grafting.

Prognosis Prognosis​ ​with​ ​treatment​ ​is​ ​rare​ ​recurrence​ ​of​ ​central​ ​hemangioma.​ ​Treatment​ ​does​ ​include​ ​risks, such​ ​as​ ​hemorrhaging. Prognosis​ ​without​ ​treatment​ ​can​ ​include​ ​mobility​ ​of​ ​teeth,​ ​facial​ ​asymmetry,​ ​pain,​ ​pulsation, supraeruption,​ ​early​ ​exfoliation​ ​or​ ​exfoliation​ ​of​ ​permanent​ ​​ ​teeth​ ​in​ ​the​ ​area​ ​of​ ​the​ ​central hemangioma​ ​have​ ​been​ ​observed.​ ​​ ​Swelling​ ​can​ ​occur​ ​and​ ​cause​ ​pain​ ​and​ ​paresthesia.​ ​Root resorption​ ​has​ ​also​ ​been​ ​observed​ ​in​ ​some​ ​patients.

Professional​ ​Relevance This​ ​lesion​ ​is​ ​important​ ​to​ ​understand​ ​and​ ​recognize​ ​as​ ​a​ ​dental​ ​hygienist​ ​because​ ​we​ ​are​ ​the​ ​first to​ ​observe​ ​the​ ​patient​ ​intra​ ​orally​ ​and​ ​possibly​ ​to​ ​view​ ​the​ ​radiographs​ ​as​ ​well.​ ​Recognizing pathology​ ​is​ ​extremely​ ​important​ ​to​ ​ensure​ ​the​ ​patient​ ​receives​ ​the​ ​treatment​ ​they​ ​need.​ ​Legally we​ ​must​ ​identify​ ​and​ ​refer​ ​out​ ​if​ ​needed​ ​to​ ​treat​ ​the​ ​pathology.​ ​It​ ​is​ ​our​ ​responsibility​ ​to thoroughly​ ​assess​ ​our​ ​patients​ ​and​ ​refer​ ​them​ ​to​ ​necessary​ ​specialists.

Bibliography

Dhiman​ ​NK,​ ​Jaiswara​ ​C,​ ​Kumar​ ​N,​ ​Patne​ ​SC,​ ​Pandey​ ​A,​ ​Verma​ ​V.​ ​Central​ ​cavernous hemangioma​ ​of​ ​mandible:​ ​Case​ ​report​ ​and​ ​review​ ​of​ ​literature.​ ​Natl​ ​J​ ​Maxillofac​ ​Surg 2015;6:209-13.

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