Venous Pool (Lake)

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Clinical Features

Dilated aneurysm of vein (lower right) is very close to surface epithelium.






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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 thereafter.

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Clinical Features

The venous 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.

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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 intravascular thrombi.

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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.

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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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