Quick Review for Patients
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The traumatic angiomatous lesion (venous pool, venous
lake, venous aneurysm) is a small, focal area of venous aneurysm
or dilation (telangiectasia?) which occurs after trauma and remains indefinitely
pool presents as a bluish or red/blue, sessile, soft, discrete,
painless nodule which is somewhat movable beneath the epithelium (Figures 1
& 2). It is usually
seen after 40 years of age, with no gender predilection, and almost all head
and neck cases are located on the lower lip mucosa or vermilion, or on the
buccal mucosa. Pressure on the feeder vessel will produce
blanching and the lesion is almost never larger than 6 mm. in greatest diameter.
It differs from varicose veins in location (varicosities are usually
on the ventral tongue), in the lack of multiple vessel involvement, and in
the nodular rather than serpiginous appearance. It differs
from the telangiectasias of hereditary hemorrhagic telangiectasia
and similar developmental disorders by the pattern and increased numbers
of vascular lesions associated with the latter.
Pathology and Differential Diagnosis
The traumatic angiomatous lesion is seen as a
single, perhaps tortuous, dilated vein located superficially beneath the
surface epithelium, above the striated muscle. The endothelial
nuclei are quite inactive and flattened and the vessel lumen is filled with
erythrocytes. There may be a slight encirclement by fibrous tissues and there
often is an organizing thrombus in the lumen (Figure 3 & 4). Lesions which are
continuously traumatized by the teeth will have chronic inflammatory cells
in the background stroma. There is no way to distinguish this lesion from
varicose veins on the basis of histopathology; both lesions may present with
Treatment and Prognosis
No treatment is necessary for this
entity, because it remains small indefinitely. Occasional
lesions may be conservatively excised, however, for esthetic reasons or for
reasons of tenderness from recurring trauma.
References (Chronologic Order)
Note: General references can be found by clicking on that topic to the left.
Weathers DR, fine RM. Thrombosed varix of oral cavity. Arch Dermatol 1971; 104:427-430.
Southam JC, Ettinger RL. A histologic study of sublingual varices. Oral Surg Oral Med Oral Pathol 1974; 38:879-886.
Alcalay J, Sandbank M. The ultrastructure of cutaneous venous lakes. Int J Dermatol 1987; 26:645-646.
Guttmacher AE, Marchuk DA, White RI. Hereditary hemorrhagic telangiectasia. N Engl J med 1995; 333:918-924.
Mirowski GW, Rozycki TW. Common skin lesions.
In: Regezi JA, Sciubba JJ. Oral pathology - clinical pathologic
correlations, 3rd edition. Philadelphia: W.B. Saunders, 1999:479-518.
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