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1. CAVERNOUS HEMANGIOMA OF FLOOR OF ORAL
CAVITY; A RARE CASE REPORT
INDIAN DENTALACADEMY
Leader in continuing Dental Education

2. Introduction
Hemangioma is believed to represent
hemartomatous malformation of normal
vascular tissue or benign neoplasm

4. Skin
SubcutaneouslyLIVER
SPLEEN
PANCREAS
BRAIN

5. Most Common I/O Sites
TONGUE
LIPS
BUCCAL
MUCOSA
PALATE

6. Can we just
ignore them
to be lost

7. It is our responsibity to revive
their lives by doing early
diagnosis so that they can be
treated as early as possible …..
www.indi

8. CLASSIFICATION OF
HEMANGIOMA
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9. CAVERNOUS HEMANGIOMA
Cavernous Hemangioma is listed as “rare
disease” by Office of Rare Diseases (ORD)
Of National Institutes of Health (NIH)
 In adults Hemangioma is rarer
presentation in floor of oral cavity

10. This paper highlights a case
report of rare pathology in adult
population and review different
aspects in its diagnosis and
treatment

11. Case presentation

12. VITAL STATISTICS AND
CHIEF COMPLAINT
AGE/SEX – 34/F
ANANDNAGAR
VADODARA
CHIEF
COMPLAINT –
PATIENT
COMPLAINS OF
SWELLING IN
THE MOUTH
BELOW THE
TONGUE SINCE
3 MONTHS

13. History of Present Illness
Asymptomatic before 3 months.
Swelling accidentally found by a
dentist while extracting 36.
Asked her to consult.
She ignored initially as the swelling was
gradually increasing and causing
intermittent pain. She visited cancer
hospital for the same.
Investigations were done & they had sent
the patient to K.M.SHAH dental hospital
for 2nd opinion.

14. No relevant Past or Present
Medical History.
Past Dental History – not
significant found.
Family History not contributory.

15. GENERAL PHYSICAL
EXAMINATION – NORMAL

17. Extra-Oral examination
• NO ABNORMALITY DETECTED.

18. Intra-Oral examination
HARD TISSUE
Missing – 36 ,Carious – 48
SOFT TISSUE
Fair oral hygiene & periodontal status.

19. Intraoral
InspectionSingle unilateral
Swelling
SIZE-3 x 1.5 cm approx
LOCATION- On right
side, floor of the
mouth i.r.t 43 TO 46
anteroposteriorly
 From lingual surface
of teeth to midline in
floor of mouth not
crossing the midline
mediolaterally

20. Overlying mucosa
normal, bluish
discoloration was seen
on medial side

21. On Palpation
Findings of inspection were confirmed.
SOFT
 SMOOTH SURFACE
TENDER
NON PULSATILE
DID NOT BLANCH
 ADHERENT TO UNDERLYING
STRUCTURES

22. Ranula

24. RADIOGRAPHS
OCCLUSAL
OPG
CT-SCAN

27. A non-enhancing soft tissue lesion
Size-31.3 x 13.9 mms
Density- 52-55HU
Plain and Contrast CT neck

28. Plain and Contrast CT neck
NO rim enhancement or any abnormal
uptake of contrast. Focus of calcification
noted with in the lesion. No bony erosion
seen.
IMPRESSION – findings raise possibility of
lymphangioma?? Dermoid?? Hemangioma ??
further investigations required.

29. INVESTIGATIONS
HEMATOLOGICAL
INVESTIGATIONS WERE WITH IN
NORMAL LIMITS

30. FNAC
FNAC from swelling in floor of the
mouth.
Microscopy – The smears reveal
mainly RBCs with a few polymorphs
and lymphocytes.
No malignant cells seen.
Impression – Possibility of an
Hemangioma cannot be ruled out.

31. Treatment
COMPLETE SURGICAL EXCISON OF
THE LESION WAS DONE WITH
EXTRA PRECAUTIONS AS THE
LESION WAS CAUSING
DISCOMFORT TO PATEINT

32. SURGICAL EXCISON

33. Gross examination
SOFT TISSUE SPECIMEN
3 X 3 CM IN SIZE, BROWNISH BLACK IN
COLOR
FIRM IN CONSISTENCY
LOBULATED SURFACE.

34. Irregular Dilated Vascular Spaces Lined By
Flattened Endothelial Cells In Fibrous
Connective Tissue stroma

35. Endothelium lined vascular spaces are
engorged with large aggregates of
erythrocytes

36. SUGGESTIVE OF
CAVERNOUS HEMANGIOMA
Biopsy Report

37. Final Diagnosis

38. ASSOCIATED SYNDROMES
• RENDU-OSLER SYNDROME( GI TRACT AND CNS
INVOLVEMENT)
• STURGEWEBER SYNDROME(LEPTOMENINGEAL ANGIOMAS,
PORTWINE STAINS)
• KASABACH-MERRITT
SYNDROME(PURPURA,COAGULOPATHY,HEMOLYSIS,INTRALE
SIONAL FIBRINOLYSIS)
• MAFUCCI SYNDROME(HEMANGIOMA OF MUCOUS
MEMBRANE,DYSCHONDROPLASIA)
• VONHIPPEL LINDAU SYNDROME(HEMANGIOMA OF
CEREBELUUM OR RETINA, CYSTS OF VISCERA).
• KLIPPEL-TRENAUNAY-WEBER SYNDROME(PORTWINE
STAINAND ANGIOMATOSIS OF EXTREMITIES

39. MULTIDISIPLINARY
APPROACH
AS THE HEMANGIOMA CAN BE ASSOC
WITH LIVER, SPLEEN SKIN, PANCREAS
BRAIN and SYNDROMES A REFRAL
SHOULD BE SENT TO
GENRAL PHYSICIAN
NEUROSURGEON
DERMATOLOGY DEPT
GASTROENTROLOGIST

40. WHERE WE STAND ?
• AS A ORAL PHYSICIAN OUR MAIN
AIM IS EARLY DIAGNOSIS OF
SUCH LESIONS SO THAT OTHER
SYSTEMIC INVOLVEMENT IF
PRESENT IN PATEINT CAN BE
RULED OUT AS SOON AS
POSSIBLE.

41. CONCLUSION
Imaging studies and fine needle aspiration cytology
(FNAC) was significantly helpful in revealing the
diagnosis-PATHOLOGICAL ANALYSIS CONFIRMED
THE DIAGNOSIS OF CAVERNOUS HEMANGIOMA
It is hence mandatory to widen our arena of thinking
as a oral diagnostician and should always follow a
multidisciplinary approach for early diagnosis and
treatment………….

42. REFRENCES
• SHAFERS ORAL PATHOLOGY 5TH EDITION.
• JOURNAL OF POST GRADUATE MEDICINE VOL47
ISSUE 3 SEPT 2001 CAVERNOUS HEMANGIOMA IN
INTERPEDUNCULAR CISTERN AND REVIEW OF
LITERATURE
• E MEDICINE CAVERNOUS HEMANGIOMA LIVER
SHRINIVAS PARSAD
• CASE REPORT Year : 2004 | Volume : 41 | Issue :
4 | Page : 181-183 HEMANGIOMA OF BASE OF
TONGUE
• CAVERNOUS HEMANGIOMA WRONG
DIAGNOSIS.COM

43. REFRENCES
• Cavernous hemangioma of frontal bone a
case report indian journal of opthalomolgy
yr1991 vol39 issue 2
• Tyldesley’s oral medicine 5th edition anne
field and longman
• Essential of oral medicine silverman
eversole and true love

45. Special thanks to:
PG GUIDE-PROF.DR.RANJEET PATIL
HOD-PROF.DR.CHANDRAMANI MORE

47. LATEST TREATMENT
MODALTIES
• SURGICAL RESECTION
• LASER PHOTOCOAGULATION
(Nd:YAG photocoagulation for vascular malformations
and hemangiomas in childhood. Arch Otolaryngol Head
Neck Surg 1998;124:431-6.)
• SCLEROTHERAPY SOD MORRUHATE,PSYLLIATE.
(Sclerotherapy of benign vascular lesion with
ethanolamine oleate ooo 2005 vol100)
• CARBON DIOXIDE SNOW
• CRYOTHERAPY
• COMPRESSION

48. LATEST INVESTIGATION
MODALTIES
• ULTRASOUND
• COLOURED DOPPLER
• MRI
• DYNAMIC GADOLINIUM (GD)-
ENHANCED (MRI).
• NUCLEAR MEDICINE RBC-TAGGED
TECHNETIUM-99M(99MTC)
SCINTIGRAPHY WITH SINGLE PHOTON
EMISSION CT (SPECT)
• DIGITAL SUBSTRACTION ANGIOGRAPHY
DSA