Intravascular papillary endothelial hyperplasia with pseudoepitheliomatous hyperpasia

Received: June 18, 2018; Accepted: June 24, 2018; Published: June 30, 2018 A 42-year old apparently healthy male presented with the complaints of a swelling and bleeding. History revealed no significant findings except that he was a smoker for 10-years. On examination, a small mucosal elevation of 1 x 1 cm in size with small pin point openings was observed in the right side of the palate close to the midline raphe. Under the clinical impression of necrotizing sialometaplasia, the lesion was excised for histopathological evaluation. The microscopy showed keratinized surface epithelium with pseudoepitheliomatous hyperplasia and dilated endothelial cell lined vascular spaces with adjacent mucous minor salivary glands. High power examination of the vascular spaces revealed projection of the vessel wall into the lumen and covered by endothelial cells with admixed fibrin mesh. The vascular pathology also involved the adjacent minor salivary gland lobules (Figure 1). The differential diagnosis includes hemangioma and necrotizing sialometaplasia. The capillary size dilated blood vessel would indicate hemangioma but the tufted papillary projections are not typical of it. The presence of pseudoepitheliomatous hyperplasia may be confused with the more common necrotizing sialometaplasia, but the latter also show acinar degeneration with preservation of the lobular architecture, squamous metaplasia and inflammation. The present microscopic features are consistent with intravascular papillary endothelial hyperplasia.