COM March 2013

This is a 51-year-old male who presented with a smooth-surfaced, focally ulcerated, grey-blue, firm nodule on the hard palate (Figure 1). It is described as slow growing. It is around two cm in diameter at its greatest dimension. The swelling is ulcerated but otherwise not painful.

Figure 1. This photograph is taken at first clinical presentation and demonstrates a well-demarcated, exophytic, grey-blue nodule with ulcerated surface in the mid/lateral hard palate.

The patient’s past medical history is unremarkable and the patient is otherwise healthy.

The patient reported a slowly enlarging lesion in the hard palate. The swelling was ulcerated but not painful and was grey-blue in color. The swelling is firm and well-demarcated.

Treatment

Under local anesthesia, an excisional biopsy was performed and the lesion was conservatively but completely excised.

Excisional Biopsy

Histologic examination reveals a hemisected piece of soft tissue composed of surface epithelium with underlying fibrous connective tissue almost all occupied by blood vessels surrounded by multiple layers of smooth muscle cells (Figure 2-4). The surface shows evidence of healing ulceration. The vascular spaces have lumens containing erythrocytes and lined by one layer of flat endothelial cells. The vascular spaces are of variable shapes. The granulation tissue below the healing ulcer containing small clusters of hemosiderin pigment and is infiltrated by lymphocytes.

Figure 2. Low power (x40) the H & E histology reveals a neoplasm made up of blood vessels surrounded by layers of spindle-shaped cells. The surface epithelium shows evidence of healing ulceration.

Figure 3. Low power (x100) the H & E histology with a closer look at the neoplasm with blood vessels surrounded by layers of spindle-shaped cells.

Figure 4. High power (x200) the H & E histology with a closer look at the blood vessels surrounded by layers of spindle-shaped cells.