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LETTERS TO EDITOR  
Year : 2019  |  Volume : 62  |  Issue : 4  |  Page : 631-632
Cavernous hemangioma of uvula: A rare site


Department of Pathology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India

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Date of Web Publication14-Oct-2019
 

How to cite this article:
Rane S, Parkhi MV, Agrawal G, Ghodke A. Cavernous hemangioma of uvula: A rare site. Indian J Pathol Microbiol 2019;62:631-2

How to cite this URL:
Rane S, Parkhi MV, Agrawal G, Ghodke A. Cavernous hemangioma of uvula: A rare site. Indian J Pathol Microbiol [serial online] 2019 [cited 2019 Nov 18];62:631-2. Available from: http://www.ijpmonline.org/text.asp?2019/62/4/631/269071




Editor,

Hemangioma is one of the most common benign soft tissue tumors. Cavernous hemangioma, one of the subtype (of hemangioma), most commonly occurs during childhood and involves head and neck region. Oral cavity cavernous hemangiomas are lesser known and that involving uvula is very rare. With extensive review of literature, only five cases are seen, this is the sixth case.[1],[2],[3],[4],[5] The present case is a rare occurrence, in terms of both site and age group.

A 68-year-old male patient presented with difficulty in speech, which was insidious in onset and gradually worsening. In association, change in voice was noted. He also complained about swelling in the uvular region, which was insidious in onset and gradually progressive in size, and was associated with foreign body sensation.

Local examination of oral cavity revealed a puffy swelling in the uvula, approximately 2 × 2 cm in size, bluish in color, almost involving entire uvula. Unfortunately, the clinical photographs were not taken, so not provided. Laser excision was performed and swelling along with a small portion of normal uvula was removed to prevent recurrence. The specimen was then sent for histopathological examination. Grossly, the excised mass was approximately 2 × 2 × 1 cm, bluish brownish in color, and had an irregular surface. Microscopically, sections revealed tissue lined by unremarkable mucosa. The subepithelial tissue showed many large irregular, cystically dilated, closely packed, blood-filled spaces. These spaces were lined by flat endothelial cells with pink eosinophilic cytoplasm. Few of the vessels showed blood clots with organized thrombi that comprises at places cholesterol clefts, fibrin material, few mononuclear cell infiltrate, calcification, and recanalization [Figure 1]a and [Figure 1]b.
Figure 1: Cavernous hemangioma: (a) subepithelial tissue showing large, dilated, blood-filled vessels lined by flattened endothelium, H and E × 20; and (b) few vessels showing organized thrombi, H and E, ×20

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Hemangioma is one of the most common soft tissue tumors (7% of all benign tumors)[6] and also the most common tumor during infancy and childhood. Most hemangiomas are superficial lesions that have predilection for the head and neck region, but they may also occur internally, notably in organs such as the liver. Depending on the origin and histological features, there are many subtypes of hemangiomas, such as capillary, cavernous, verrucous, venous, arterio-venous, spindle cell hemangioma, epitheloid hemangioma, etc.

Cavernous hemangiomas are most common in childhood and located in the upper portion of the body. They are usually larger than capillary hemangioma, less circumscribed, and more frequently involve deeper structures. They show no tendency to regress and may lead to exert pressure symptoms on neighboring structures. Consequently, most cavernous hemangiomas require surgery (excision of the lesion or uvulectomy), in contrast to their capillary counterpart. Grossly, superficial lesions present as blue puffy masses with irregular surface caused by dilatation of the vessels.

The common complications of hemangiomas include pressure symptoms, bleeding, and rupture.[7] Cavernous hemangiomas of uvula, till date, have not been reported to cause any such severe complication except obstructive symptoms like snoring, mild dysphagia, speech difficulties, etc. The explanation behind may be the foreign body sensation it causes, leading to an early attention, diagnosis, and treatment. But applying our conceptual knowledge regarding hemangiomas in general, a cavernous hemangioma can cause complications such as trace amount of per oral bleed to a massive bout of blood due to rupture, thereby mimicking completely unrelated pathologies. What adds to these possibilities is the injury-prone site of the lesion.

To conclude, uvula is an extremely rare site for cavernous hemangioma with only five cases reported till date. Though all the cases have been reported in the past decade with an increase in the number, the etiology is still unknown. Also, hemangiomas most commonly occur in infancy and childhood. Thus, this case represents a rare site and a rare age group for a cavernous hemangioma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Thomas R, Ramalingama SBJ, Samuela J, Kumara KD. Cavernous hemangioma of the uvula - A case report. Sri Ramachandra J Med 2009;1:36-7.  Back to cited text no. 1
    
2.
Iarlykov SA. Hemangioma of the uvula in a 6 month old child. Vestn Otorhinolaryngol 1964;26:93-4.  Back to cited text no. 2
    
3.
Sobrinho FP, Felix MA, do Valle AC, Lessa HA. Hemangioma of uvula: One case report. Rev Bras Otorrinolaringol 2003;69:571-4.  Back to cited text no. 3
    
4.
Pai V, Thomas H, Stewart C. Long uvula: An unusual cause of chronic cough. Postgrad Med J 2004;80:116.  Back to cited text no. 4
    
5.
Wang M, Chen S, Mojica WD, Chen F. Cavernous hemangioma of the uvula: Report a rare case with literature review. N A J Med Sci 2015;8:56-8.  Back to cited text no. 5
    
6.
Weiss SM, Goldblum JR. Benign vascular tumors and malformations. Enzinger and Weiss's Soft Tissue Tumours. 6th ed. Philadelphia: Mosby Elseveir; 2013. p. 655-96.  Back to cited text no. 6
    
7.
Rosai J. Soft tissues. Rosai and Ackerman's Surgical Pathology. Vol 2, 10th ed. Philadelphia: Mosby Elseveir; 2011. p. 2150-3.  Back to cited text no. 7
    

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Correspondence Address:
Mayur V Parkhi
Department of Pathology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, Maharashtra - 411 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_435_18

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