Fig. 2. (4×Magnification) Hematoxylin-eosin staining showing
features suggestive of lobular capillary hemangioma.
The patient was then referred to the Department of Oral Surgery for further management where the whole lesion was excised and sent for biopsy. The second biopsy report was also suggestive of lobulated capillary hemangioma.
DISCUSSION
Haemangiomas constitute about 7% of all benign tumors in infancy and childhood9. An increase in the number of normal or abnormal vessels engorged with blood is characteristic of these entities. These lesions are broadly identified as (a) cavernous and (b) capillary haemangioma. Cavernous haemangiomas are composed of large dilated vascular channels that can infiltrate and involve deeper structures making spontaneous regression a rare possibility. Capillary haemangiomas are more common in comparison to cavernous type. These occur in the skin, subcutaneous tissues, and mucous membranes of the oral cavity, lips as well as in the liver, spleen, and kidneys9.
Lobular capillary haemangiomas are a benign proliferation of capillaries that usually arise on the face, lips, or hands after episodes of minor trauma10.
They do not show age preponderance but are more common in children and young adults, especially in men. It displays various clinical features suggestive of reactive neovascularisation. It has a limited capacity to grow, with a propensity for multiple eruptions that may be localized or disseminated.
Lobular capillary haemangioma remains an etiopathological enigma. Trauma, inflammatory and infectious agents are the suspected causative factors. It is a relatively common benign mucocutaneous lesion occurring intraorally or extra orally. It is a common lesion that presents with varying clinical features that may sometimes mimic more serious lesions such as malignancies.
Lobulated capillary haemangioma may resemble a squamous cell carcinoma because it usually has an ulcerated patch on its surface. It is softer on palpation and bleeds easily, and usually, its instigating irritant can be found11.
In a review of 639 vascular lesions of the oral cavity and upper respiratory tract 73 cases presented with characteristic features of Lobulated capillary haemangioma. Among the various sites, the lip was the most common site involved (38%). LCH presents as a spontaneous, painless, bleeding mass. There is a predilection for males less than 18 years old, females in the reproductive years, and an equal sex distribution beyond 40 years of age12.
As an adage says, ‘Eyes cannot see what the mind does not know’, a clinician, not cognisant of the possibility of this lesion in its unusual site mistakes it for the more serious ones and might jump to conclusions which often leads to misleading results, uncertainty, and mistrust. This is easily overcome by histopathology which confirms its innocuous nature.
CONSENT STATEMENT: Written informed consent was obtained from the patient’s guardian as per guidelines to publish this report.
FUNDING: None
ACKNOWLEDGEMENT: None
CONFLICTS OF INTEREST: The authors have declared no conflict of interest.
ETHICS STATEMENT: None
DETAILED AUTHOR’S CONTRIBUTION:
1. Rajlaxmi Mitra
Writing-Original draft
2. Akhilanand Chaurasia
Writing-Review and Editing
3. Ranjit Kumar Patil
Supervision and validation
DATA AVAILABILITY STATEMENT: None
REFERENCES
  1. Glick M. Burket’s oral medicine. PMPH USA; 2015.
  2. Sivapathasundharam B. Shafer’s Textbook of Oral Pathology-E Book. Elsevier Health Sciences; 2016 Jul 25.
  3. Minhas S, Sajjad A, Kashif M, Taj F, Al Waddani H, Khurshid Z. Oral ulcers presentation in systemic diseases: An update. Open access Macedonian journal of medical sciences. 2019 Oct 10;7(19):3341.
  4. Sarangarajan R, Vedam VV, Sivadas G, Sarangarajan A, Meera S. Traumatic ulcerative granuloma with stromal eosinophilia–Mystery of pathogenesis revisited. Journal of pharmacy & bioallied sciences. 2015 Aug;7(Suppl 2):S420.
  5. Neville BW, Damm DD, Allen CM, Chi AC. Oral and maxillofacial pathology. Elsevier Health Sciences; 2015 May 13.
  6. Glick M. Burket’s oral medicine. PMPH USA; 2015.
  7. Gupta A, Narwal A, Singh H. Case report: primary labial tuberculosis: a rare presentation. Annals of Medical and Health Sciences Research. 2014;4(1):129-31.
  8. Kamala KA, Ashok L, Annigeri RG. Herpes associated erythema multiforme. Contemporary clinical dentistry. 2011 Oct;2(4):372.
  9. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease, professional edition e-book. Elsevier health sciences; 2014 Aug 27.
  10. Sheehan DJ, Lesher JL. Pyogenic granuloma arising within a port-wine stain. CUTIS-NEW YORK-. 2004 Mar 1;73(3):175-80.
  11. Wood NK, Goaz PW. Differential diagnosis of oral lesions. Mosby Elsevier Health Science; 1985.
  12. Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. The American Journal of surgical pathology. 1980 Oct 1;4(5):470-9.