Beyond the Surface, Intravascular Papillary Endothelial Hyperplasia (IPEH): A Case Report

This case report aims to contribute to the understanding and documentation of intravascular papillary endothelial hyperplasia (IPEH) in the oral cavity, emphasizing its significance in clinical practice. We report a 65-year-old female patient with reddish swelling over the left lateral border of the tongue for two months. The swelling was non-tender and non-pulsatile. Excisional biopsy under local anaesthesia was done. On histopathological examination, it was diagnosed as IPEH based on two key features: anastomosing and interconnecting papillary projections of endothelial cell proliferation, and the other part of the stroma consisting of a fibrous pseudocapsule comprising the residue of smooth muscles or elastic fibres of blood vessels around the thrombus. Intravascular papillary endothelial hyperplasia constitutes only 2% of all vascular tumours, most commonly of the head and neck region. Since it has no pathognomonic features, it is often misdiagnosed clinically as mucocele, haemangioma, pyogenic granuloma, or melanoma. It is of utmost importance to diagnose this entity correctly, as it is often confused with angiosarcoma both clinically, due to its appearance, and histologically. Complete surgical excision remains the treatment of choice, ensuring definitive management and minimizing the risk of recurrence. IPEH is a rare vascular lesion that poses significant diagnostic challenges due to its clinical and histopathological resemblance to various benign and malignant entities. This case highlights the importance of accurate differentiation, particularly from angiosarcoma, to prevent unnecessary aggressive treatment. A meticulous approach combining clinical assessment, histopathological examination, and patient history is crucial in establishing a precise diagnosis and guiding appropriate management.