Epithelioid Hemangioma of Lingual Alveolar Mucosa: An Immunohistochemical Case Report

Epithelioid hemangioma is a rare benign vascular lesion that presents as a nodular lesion in the skin of head and neck region. It is a superficial vascular entity which can either be due to tumor or reactive lesion, but the exact etiology is still unknown. We hereby present a rare case which has been reported with the history of small nodular-like growth on mandibular buccal and lingual area. The excisional biopsy was performed and tissue was submitted for histopathological diagnosis. The immunohistochemistry was performed to check the expression of CD31 marker which proved that origin of epithelioid cells was vascular. 1. Introduction Hemangiomas are the benign vasoformative tumors, characterized by an increase in number of blood vessels especially veins and capillaries in a focal area of submucosal connective tissue and are self-involuting in nature. The “hemangioma” in Greek means haema: “blood”, angeio: “vessel”, and oma: “tumor,” that is, a blood vessel tumour. Oral hemangiomas represent 14% of all human hemangioma. There are various subtypes of hemangioma like capillary hemangioma, lobular hemangioma, cellular hemangioma, and epithelioid hemangioma. Epithelioid vascular tumors are a diverse group of lesions which are characterized by endothelial cells which are epithelioid in appearance. These include three variants: benign vascular tumors or epithelioid hemangioma, borderline tumors, that is, epithelioid hemangioendothelioma, and malignant tumors—epithelioid angiosarcoma [1]. Epithelioid hemangioma (EH) is an uncommon lesion, which occurs with greater frequency in the head and neck region [2]. Wells and Whimster first reported it as angiolymphoid hyperplasia with eosinophilia (ALHE) in 1969 and Rosai et al. termed it as histiocytoid hemangioma in 1979. The term epithelioid hemangioma was first used by Enzinger and Weiss in 1983 to describe the benign counterpart of the vascular lesions [3]. Epithelioid hemangioma typically arises on the head and neck, but the intraoral sites which are more frequently affected are lips, buccal mucosa, and tongue. The extracutaneous sites which are more commonly affected are bone, salivary gland, and muscular area or extremities. There are only limited intraoral cases of EH and only 16 cases have been reported in the English literature [4]. The etiology and pathogenesis of this vascular entity is still uncertain. This entity typically presents as a small angioma-like nodule, red to brown in color and may be located intradermally or subcutaneously in young adults. EH can mimic lymphoproliferative disorders,