PMC4573417_01
Initial presentation showing a small area of gingival swelling and erythema labially and lingually around the LL1 and LL2. Histological appearance of the initial lesion shows: left; area with typical zoning and central hyalinised nodule, centre; area with haemangioma-like vessels with prominent endothelium (haematoxylin and eosin), right; positive pericytic staining with smooth muscle actin immunohistochemistry.
gr1.jpg
PMC4573417_01_gr1.jpg
fig0005
She presented with a five year history of a small area of gingival swelling and erythema buccally and lingually around the lower left incisors, which were slightly mobile (Fig. 1). Review of two previous biopsy specimens of the initial lesion, that had proved inconclusive when reported at another hospital, showed features of EHE (Fig. 1).
Clinical presentation 7 years after formal diagnosis (a) labial aspect showing gingival swelling and erythema between LR1 to LL4, and (b) lingual aspect (mirror image).
gr2.jpg
PMC4573417_01_gr2.jpg
fig0010
The patient was followed up closely, and the condition remained stable for the following 7 years at which point a new lesion presented as an erythematous patch with associated gingival swelling on the buccal gingivae between LR1 to LL3, and on the lingual gingival between LR1 and LL4 (Fig. 2).
showing postoperative healing shortly after soft- tissue surgical excision of the recurrence.
gr3.jpg
PMC4573417_01_gr3.jpg
fig0015
Fig. 3 shows the postoperative presentation shortly after soft-tissue surgical excision of the recurrence.
Clinical presentation 21 years after initial presentation showing some calculus deposits and recession around the lower incisors, but no evidence of recurrence.
gr4.jpg
PMC4573417_01_gr4.jpg
fig0020
She has been reviewed for a further five years, with no change in clinical signs or symptoms and no evidence of recurrence (Fig. 4).
Upper row; radiographic presentation at time of diagnosis showing vertical bone loss around the LL1 and LL2. Middle row; appearance at recurrence 7 years after diagnosis showing increased bone loss. Bottom row; 19 years after initial presentation showing stability of bone levels.
gr5.jpg
PMC4573417_01_gr5.jpg
fig0025
Intraoral radiographs showed that the lesion was associated with a vertical bony defect of approximately 3 mm (Fig. 5a). Radiographs showed further horizontal and vertical bone loss around these teeth. (Fig. 5b). Radiographic estimation of the bone loss in annual sequential radiographs suggested no further loss of bone, and clinical signs remained stable. (Fig. 5c).