TUMOR DE MASSON DE CAVIDAD ORAL: PRESENTACIONES CLÍNICAS

Abstract

INTRODUCTION: Masson tumor or intravascular vegetative hemangioendothelioma is an endothelial hyperplasia that forms papillae inside the vessel, being able to occlude and thrombosed it with necrosis and local infarcts constituting irregular reddish tumors of preferential location in skin and kidney, being very rare in other locations such as the oral cavity. They have a non-indurated, depressible and fragile elastic consistency along with a slowly progressive growth except in exceptional circumstances that may justify a sudden growth.MATERIAL AND METHODS: Two case reports are provided. The first one is a male patient assited for repeated hematemesis without initially identified origin. A Masson tumor of hard palate hidden by dental prosthesis which was resected by bipolar forceps after infiltration with perilesional serum to promote devascularizstion was demonstrated. The second case was a young woman who, in relation to the intake, presented a significant hematemesis. The assessment of urgencies and digestive endoscopy did not identified the origin of bleeding in the digestive tract, although the endoscopist was able to recognize a new bleeding episode but from the oral cavity. The ENT examination demonstrated a small reddish tumor of vascular appearance in the left bittting retromolar area, bleeding at the minimum friction. A resection was performed without any incidence according to the former described technique and anatomopathological diagnosis. The antecedent of previous minor episodes was assessed. DISCUSSION: Masson tumors are very rare conditions in the digestive tract ,and exceptional in the oral cavity, that have been related to repeated irritations or local traumatisms, encapsulated hematomas or the preexistence of other vascular lesions. These factors seem to have occurred in our patients (rubbing of dental prostheses in paladoar and repetitive self-bitting). They are slowly growing masses in which thrombotic phenomena frequently occur. However, the rubbing of its surface can lead to important bleeding as reported. Differential diagnosis with malignant tumors, mainly the angiosarcoma of which it is distinguished by its encapsulation, good delimitation and the absence of cellular atypia must be made. Surgery is the treatment of choice , requiring wide complete excision as well as suppression of irritating factors. In our patients, once the origin of the bleeding was identified, simple resection of the tumor was performed, with prior perilesional injection of saline solution to reduce its vascularization, by means of bipolar forceps electrocautery without incidents and without recurrence. CONCLUSION: Masson tumor is a curiosity that rarely leads to situations of risk such as those described, but it must be diagnosed correctly and differentiated from other vascular tumors. The suspicion of irritative-traumatic etiology, as in these patients because of its relationship with dental prosthesis in the first and bitting in the second is clear. Repeated traumas that can cause recurrences and bleeding should be avoided. The meticulous ENT examination removing prosthesis and visualizing all the nooks of the upper aerodigestive tract, and of the mouth in particular, in any oral bleeding is mandatory.