Clinical and hystopathological dilemmas in diagnosis of epitheloid hemangioma of maxillae-case report

Epithelioid hemangioma (EH) is a rare benign tumor involving the blood vessels and surrounding epithelioid cells. Epitheloid hemangioma, also called histiocytoid hemangioma, angiolymphoid hyperplasia with eosinophilia (ALHE), is a very rare benign tumor in maxillofacial region. There is a controversy in regards to correct diagnosis of an epithelioid hemangioma (EH), particularly when arising in skeletal locations, because of aggressive clinical characteristics, including multifocal presentation and occasional lymph node involvement. Specifically, its distinction from epithelioid hemangio-endothelioma (EHE) has been controversial. In literature we did not find a case where EH involves maxilla. However, there are few cases reported in which EH involved maxillary sinus and nasal cavity. We will present a case of 21 year old male, who came to our Department with a lesion in frontal maxillary region. He underwent surgery four times, wide excision, and with four different histopathology results. The last result was ephiteloid hemangioma with metaplastic bone formation – a very rare benign lesion in oral region, but clinically with very aggressive nature.