Papillomatous Lesion of the Right Retromolar Area With Underlying Endothelial Proliferation: A Diagnostic Challenge.

Background: The surface appearance of an oral lesion may not accurately indicate the process occurring in the underlying connective tissue. Vascular proliferations covered by papillary epithelial hyperplasia may therefore clinically resemble benign epithelial lesions. Case Presentation: A 59-year-old man with multiple coronary stent placements and ongoing anticoagulant therapy presented with a painless, pedunculated lesion in the right retromolar area. He reported no history of tobacco or alcohol use. The lesion had been noticed approximately 2 weeks earlier and was repeatedly contacted by the adjacent mandibular right third molar. Its exophytic papillomatous surface suggested squamous papilloma or verruca vulgaris. An excisional biopsy was performed using a 980-nm diode laser, with minimal intraoperative bleeding. Microscopic examination demonstrated papillomatous epithelial hyperplasia overlying numerous endothelial-lined vascular channels of predominantly capillary caliber, establishing a diagnosis of capillary hemangioma. At the 2-week follow-up, the surgical site showed satisfactory mucosal healing without a clinically evident residual lesion. Conclusion: This case demonstrates that a clinically epithelial-appearing oral lesion may have an underlying vascular origin. Correlation of the clinical and histopathologic findings is therefore important when evaluating excised papillomatous lesions.