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Case of the Month

Before treatment on chest

70-year-old man presents with an enlarging nodule on his right lower lip. He says it started about 3 years ago and has progressively enlarged. He can’t remember any history of bite trauma before it started. No other oral lesions. He presents for evaluation and removal because it is tender with pressure and he is constantly asked about the ‘big bump on his lip.’


Diagnosis: Oral Angioleiomyoma

Angioleiomyomas are rare, benign, solitary tumors of vascular smooth muscle origin. They can be painful. They usually appear on the legs. There is an oral variant that should be considered in the differential diagnosis with all oral /lip nodules.

Before treatment on chest
Before treatment on chest
Before treatment on chest
Before treatment on chest

Reference:

Angioleiomyoma affecting the lips: report of 3 cases and review of the literature.
Med Oral Patol Oral Cir Bucal. 2011 Jul 1;16(4):e482-7.
Gueiros LA1, Romañach MJ, Pires-Soubhia AM, Pires FR, Paes-de-Almeida O, Vargas PA.

Abstract
Angioleiomyoma is an uncommon benign soft tissue tumor usually found in the lower extremities and rarely observed in oral tissues. It is microscopically characterized as a proliferation of smooth muscle cells intermingled with abundant vascular channels. Oral angioleiomyomas affect mostly the lips, palate, buccal mucosa and tongue, and appears as a submucosal painless nodule. Upper lip is seldom affected and only few cases have been reported. We report three additional cases of angioleiomyoma affecting the lips of elderly patients. All lesions were asymptomatic and presented as submucosal nodules of approximately 1cm. Microscopic analysis on H&E sections revealed similar pattern in all cases, showing well-circumscribed and encapsulated tumors characterized by proliferation of smooth muscle cells and large amount of wide vascular spaces of varying sizes. Most tumor cells were immunoreactive for a-smooth muscle actin, desmin and HHF-35. CD34 was also positive on the endothelial cells. All patients were surgically treated and no recurrence was observed so far. The oral pathologists and clinicians should consider this entity when assessing nodular lesions on upper lip.
PMID: 20526260 DOI: 10.4317/medoral.16.e482
Ref: https://www.ncbi.nlm.nih.gov/pubmed/20526260


Charles Crutchfield III M.D. Eagan Dermatologist

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