Caliber-persistent Labial Artery Research Articles

Artéria labial de calibre persistente: um diagnóstico frequentemente negligenciado

Caliber persistent labial artery (CPLA) is a vascular abnormality in which the main branch of the artery responsible for the blood supply to the lips penetrates into the submucosal tissue without reduction of its diameter, appearing clinically as an elevated and pulsatile nodule on the lips. CPLA can be considered as a common alteration, however, it is a frequently misdiagnosed anormality, since it may share clinical features with other conditions. The aim of this study is to report a case of CPLA in the upper lip of a 33-year-old female patient whose diagnostic hypothesis was salivary gland tumor. Due to its characteristics, CPLA should be considered as a differential diagnosis once evaluating a lip lesion. Furthermore, it is important to be aware of possible complications caused by surgical procedures such as hemorrhage.

CALIBER-PERSISTENT LABIAL ARTERY: SERIAL CASES WITH DIAGNOSIS AND TREATMENT

The caliber-persistent labial artery is a common vascular anomaly, which is characterized by a major arterial branch that extends to the surface of the submucosal tissue without reducing its diameter. It occurs exclusively in the labial mucosa and its incidence is approximately 3% of the general population without significant difference between sex. The diagnosis depends on clinical evaluation with the presence of a purple pulsatile papule and can be confirmed by high-resolution color Doppler ultrasound. This type of lesion mimics other oral pathologies such as mucoceles and reactional lesions and the misdiagnosis might cause bleeding during biopsy or surgery. This vascular anomaly was reported to occur in other sites: eyes, intestine, stomach, heart, and upper and lower lip. We present 5 cases of caliber-persistent artery with clinical features and Doppler color ultrasound. One of the patients underwent surgery with arterial ligation due to aesthetics alterations. The caliber-persistent labial artery is a common vascular anomaly, which is characterized by a major arterial branch that extends to the surface of the submucosal tissue without reducing its diameter. It occurs exclusively in the labial mucosa and its incidence is approximately 3% of the general population without significant difference between sex. The diagnosis depends on clinical evaluation with the presence of a purple pulsatile papule and can be confirmed by high-resolution color Doppler ultrasound. This type of lesion mimics other oral pathologies such as mucoceles and reactional lesions and the misdiagnosis might cause bleeding during biopsy or surgery. This vascular anomaly was reported to occur in other sites: eyes, intestine, stomach, heart, and upper and lower lip. We present 5 cases of caliber-persistent artery with clinical features and Doppler color ultrasound. One of the patients underwent surgery with arterial ligation due to aesthetics alterations.

CALIBER-PERSISTENT LABIAL ARTERY: REPORT OF A CASE WITH EMPHASIS ON HISTOPATHOLOGIC FINDINGS

Caliber-persistent labial artery consists of an expanded part of the main branch of the labial artery that penetrates the submucosal tissue without loss of caliber. A 67-year-old woman presented a lesion on the upper lip, pulsating with no painful symptomatology, with implantation in the submucosa. The patient had no history of allergies and systemic diseases. At histopathologic analysis, a thick artery with a stenotic lumen was seen, where there was anatomic preservation of all structures. At the periphery of the adventitial layer, structures suggestive of primary and secondary lymphoid follicles with apparent formations of germinal centers were observed. Immunohistochemical staining for CD20, CD68, CD4, desmin, and CD34 was performed to confirm the structures suggestive of lymphoid follicles, and histochemical staining for Verhoeff was performed. The histopathologic and immunohistochemical findings escape the normality pattern, provoking discussions about what would they represent in the pathogenesis of this lesion.

Caliber-Persistent Labial Artery: A Rarely Recognized Cause of a Lower Lip Swelling—Report of 5 Cases and Review of the Literature

Caliber-persistent labial artery (CPLA) is a vascular anomaly of the labial artery that penetrates into the submucosa of the lip without reduction in diameter. It commonly presents as a bluish or normal-colored elevated mass and usually pulsates on manual palpation. It can resemble a mucocele or squamous cell carcinoma if surface ulceration presented. CPLA carries the risk of profuse bleeding if the artery undergoes transection during biopsy. Five patients aged between 28 and 88 years presented with discrete lesions of the lower lip. All cases were diagnosed clinically as either mucocele or squamous cell carcinoma and were treated with excisional biopsy. The specimens showed a prominent muscular vessel in the stroma that was associated with ulceration in 2 cases. Hemostasis was achieved by either application of surgical diathermy or ligation with deep sutures at the wound area. Persistence of the lesion after excision was seen in only 1 case, another single case the patient complained of persistent paresthesia at the surgical site at 7 months review after biopsy. CPLA should be considered in the differential diagnosis of any raised soft tissue lesion affecting the lip. Careful inspection with palpation for pulse during clinical examination should permit an accurate clinical diagnosis and may prevent unnecessary surgical treatment or prepare the operator for the possibility of hemorrhage during surgery. Pathologists can be alerted to the possibility of CPLA where an isolated muscular vessel is encountered during lip biopsy.

High‐resolution color Doppler ultrasound of a caliber‐persistent artery of the lip, a simulator variant of dermatologic disease: case report and sonographic findings

Caliber-persistent labial artery (CPLA) is a vascular anomaly in which a primary artery penetrates the submucosa without caliber loss. It presents as an asymptomatic papular lesion, usually on the lower lip, which may be misdiagnosed as a malignant skin tumor and can cause severe bleeding during biopsy or surgery. Development of new high-resolution ultrasound equipment has improved its observation. This study was undertaken to assess the scope of ultrasound for the diagnosis of CPLA. We report a case of a 65-year-old woman with a nodule involving the lower lip, initially misdiagnosed as a malignant skin tumor. Diagnosis was confirmed by high-resolution color Doppler ultrasound using a compact linear probe that generates frequencies of 7-15 MHz. The clinical presentation of the lesion, ultrasound technique, and sonographic findings are described. A current literature review of CPLA diagnosis was performed. Clinical and sonographic images are given as examples. High-resolution color Doppler ultrasound is a reliable noninvasive technique for CPLA diagnosis. It allows direct visualization of this vascular variant in real time without the use of an intravenous contrast agent. It may avoid surgical complications and help in the differential diagnosis. Newer high-resolution equipment allows a clear definition of the cutaneous and muscular layers, as well as the vascularity of the lips.

Ultrasonography: A Noninvasive Tool to Diagnose a Caliber-Persistent Labial Artery, an Enlarged Artery of the Lip

Currently, practitioners use clinical and histopathologic examination to diagnose a caliber-persistent labial artery (CPLA). We illustrate the use of ultrasonography as a noninvasive diagnostic tool to visualize this enlarged artery of the lip. We examined the lips of 3 patients with a suspected CPLA. We localized and determined the extension of the intralabial artery with ultrasonography, including pulsed and color Doppler analysis. We compared the sonograms to the clinical and histopathologic findings. Sonograms showed clear enlargement of the labial artery in the 3 cases. The course of the constant-diameter artery was either vertical or oblique from the depth of the lip to the surface of the mucosa. This vascular abnormality was confirmed by histopathologic examination. Ultrasonography and color Doppler imaging may be useful noninvasive tools for the diagnosis and preoperative evaluation, as well as the follow-up, of labial lesions related to a CPLA, thus eliminating the need for diagnostic surgery in typical pulsatile nodules. Ultrasonography may help distinguish a CPLA from other vascular lesions of the lip such as an aneurysm. Atypical cases or chronic ulcerations mimicking a cancer should undergo biopsy so that a malignant process is not missed.

Caliber-persistent labial artery: A common vascular anomaly

Sixteen cases of caliber-persistent labial artery of the lips have been reported to date in the English literature. Six of these were clinically misdiagnosed as squamous cell carcinoma and treated with wedge resection. To date, we have seen 187 cases clinically and an additional 23 cases through our surgical oral pathology services. Careful clinical observation usually reveals a soft linear or papular bluish elevation above the labial mucosal surface. The unique feature is pulsation—not simply pulsation toward and away from the observer, which can be caused by an underlying artery, but lateral pulsation, which only an artery can exhibit. All but 2 of our 187 clinical cases were asymptomatic. To the best of our knowledge, this is the first report of caliber-persistent labial artery of the upper lip. The upper:lower lip ratio for the clinical cases was almost 2:1. Three times as many lower lip as upper lip lesions were biopsied. Males and females were almost equally affected (clinical cases, 76:86; histopathologic cases, 9:13). Although a vascular term ( artery, hemangioma, phlebolith, varix, vascular malformation) was used on the biopsy form in one half of the clinical differential diagnoses, none of the clinical histories mentioned pulsation. In contrast to the cases of Miko et al. in 1980 and 1983, none of our cases manifested itself as an ulcer, nor was carcinoma ever mentioned in the clinical differential diagnosis. The purpose of this article is to familiarize clinicians and pathologists with the clinical and histopathologic features of this seldom reported but common vascular anomaly. Clinicians should carefully look for lateral pulsation in lip mucosal papules so as to avoid unnecessary surgery and intraoperative arterial bleeding. Pathologists should recognize that a relatively large-caliber superficial artery in a lip biopsy may not be an incidental finding but rather the clinical lesion that was biopsied.

Caliber-persistent labial artery: A common anatomic variant of normal

Caliber-persistent labial artery: A common anatomic variant of normal

Clinical diagnosis of caliber-persistent labial artery of the lower lip

Only 14 cases of caliber-persistent labial artery of the lower lip have been reported to date. Six of these were misdiagnosed and treated as squamous cell carcinoma, another as a mucocele. The correct diagnosis emerged only after the wedge resections were examined histopathologically. We report the first cases of caliber-persistent labial artery to be diagnosed clinically since the original description of the condition by Howell and Freeman in 1973. Our first case was a nonpulsatile hard, linear, “gooseneck lamp” submucosal nodule of the lower lip. On the basis of an initial misdiagnosis of sclerosing sialadinitis, a biopsy was attempted. Brisk pulsatile bleeding proved the lesion to be an artery, and the superficial location and large diameter of the vessel lead to the clinical diagnosis of caliber-persistent labial artery. The “gooseneck lamp” hardening is typical of Monckeberg's arteriosclerosis. The second case was a pulsatile blue linear submucosal nodule of the lower lip. The clinical diagnosis of caliber-persistent labial artery was confirmed when angiography showed the lesion to be an abnormally dilated labial artery. Both cases were successfully ligated with no complications at 16 and 10 months after surgery.