Nagaraja A, Kumar N Govindraj, Kumar B Jambukeshwar, Naik Raghavendra M, Sangineedi Y Jyoti
Professor, Department of Oral and Maxillofacial Pathology, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh India, e-mail:
Department of Oral and Maxillofacial Pathology, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh India.
J Contemp Dent Pract. 2016 Aug 1;17(8):706-10. doi: 10.5005/jp-journals-10024-1916.
Pathological conditions can give rise to calcifications within oral mucosa representing either a local or systemic disturbance. Inflammation, trauma, debris acting as nidus and vascular lesions have been attributed as principal causes for occurrence of calcifications within the oral mucosa. Occurrence of multiple calcified thrombi (phleboliths) is considered pathognomonic for hemangiomas and vascular malformations in the oral and maxillofacial region. Isolated occurrence of phlebolith in oral mucosa though very rare, especially without any underlying vascular lesions, can be diagnostically challenging. Either a traumatic association at that site or a hemangioma of childhood that has regressed once the individual became an adult are the possible explanations suggested for the occurrence of these unique solitary phleboliths. Histologically, an "onion-ring"-like concentric lamellar fibrosis around a central core with varying amounts of calcifications and presence of minute vascular channels within or around calcified lamellae is characteristic for phlebolith. There is a high propensity for misdiagnosing solitary phlebolith located in sites like the buccal mucosa where various other pathologic soft-tissue calcifications, such as sialoliths, calcified lymph nodes, traumatic myositis ossificans, etc. can occur and they too appear radiopaque in radiographs. Besides, the absence of any associated underlying vascular lesion adds to the mispercep-tion. In such cases, histopathological examination with routine hematoxylin and eosin staining alone may not be sufficient to determine the accurate diagnosis. Allied clinical history and immunohistochemistry can aid to arrive at the final diagnosis. We report such a case of nonvascular lesion-associated solitary phlebolith in the right buccal mucosa of a healthy 49-year-old male patient and discuss its differential diagnosis with emphasis on histological presentation.
病理状况可导致口腔黏膜内出现钙化，这代表着局部或全身的紊乱。炎症、创伤、作为病灶的碎屑和血管病变被认为是口腔黏膜内钙化发生的主要原因。多发性钙化血栓（静脉石）的出现被认为是口腔颌面部血管瘤和血管畸形的特征性表现。静脉石在口腔黏膜中孤立出现虽然非常罕见，尤其是在没有任何潜在血管病变的情况下，诊断可能具有挑战性。该部位的创伤关联或个体成年后已消退的儿童期血管瘤是这些独特孤立静脉石出现的可能解释。组织学上，静脉石的特征是围绕中央核心的“洋葱环”样同心层状纤维化，伴有不同程度的钙化，且钙化薄片内或周围存在微小血管通道。位于颊黏膜等部位的孤立静脉石很容易被误诊，因为在这些部位可能出现各种其他病理性软组织钙化，如涎石、钙化淋巴结、创伤性骨化性肌炎等，它们在X线片上也表现为不透光。此外，没有任何相关的潜在血管病变会增加误诊的可能性。在这种情况下，仅用常规苏木精和伊红染色进行组织病理学检查可能不足以确定准确诊断。相关的临床病史和免疫组织化学有助于做出最终诊断。我们报告了一例健康49岁男性患者右侧颊黏膜非血管病变相关的孤立静脉石病例，并重点讨论其组织学表现的鉴别诊断。
