Correspondence Address:
Sudheer Arava
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India

Full Text

Editor,

Angiokeratomas are clinically distinct benign cutaneous vascular malformations commonly occur in the lower extremities. They may be congenital or acquired. Solitary angiokeratomas are usually asymptomatic and multiple angiokeratomas are usually associated with Fabry's disease. [1],[2] Rarely angiokeratomas may ulcerate and bleed. Solitary symptomatic angiokeratoma at unusual sites are the potential cause of worry and distress to the patient and causes clinical diagnostic difficulties.

Here we are presenting a case of 26-year-old male patient came with the history of recurrent bleeding and pain from the dorsal surface of the tongue since 6 months. On examination, a single, irregular, salmon pink to dark brown colored, gradually increasing, wart like growth measuring 2 cm × 1.5 cm was present on the dorsal surface of the tongue. Rest of the systemic examination was normal. With these clinical findings, a suspicion of early squamous cell carcinoma of the tongue was made. The growth was excised and sent for histopathology.

Microscopy revealed presence of dilated ectatic vascular channels predominantly located in the papillary dermis with pseudoepitheliomatous hyperplasia of the overlying epithelium. There was no evidence of dysplasia or malignancy [Figure 1]. With this classical histomorphology, the diagnosis of angiokeratoma was made.{Figure 1}

Usually symptomatic angiokeratomas at unusual sites causes difficulty in the diagnosis because of their varied clinical presentation and appearance. Color may vary from black to dark red to pink and clinically they are commonly mistaken as melanoma, wart, naevi, seborrheic keratosis and occasionally malignancy. [1],[3] Solitary angiokeratoma of the tongue with history of pain and recurrent bleeding is mistakenly diagnosed as squamous cell carcinoma in our case. The histopathological diagnosis is mandatory for the definitive diagnosis.

Although trauma and altered hemodynamics which produce telangiectatic vessels are the possible mechanisms but exact pathogenesis of this lesion is still unknown. Laser ablation and complete resection are the treatment of choice in symptomatic lesions. [4]

Oral mucosal involvement is common in the systemic form, and it is extremely rare in localized form. Hence this lesion should be kept as a differential diagnosis of verrucous lesion before considering an erroneous diagnosis of malignancy.

References