Intraosseous composite hemangioendothelioma of the mandible: case report and literature review

Composite hemangioendothelioma (CHE) is a locally aggressive intermediate malignant vascular tumor characterized by a mixture of histologic patterns. CHE is considered to be an intermediate malignant tumor, which mainly occurs in the dermis and subcutaneous lesions of the limbs, and may grow and invade nearby bones. CHE occurs in the mandible are rare, especially in its ramus. Because of its rarity, in the mandible, CHE must not only be distinguished from other vascular tumors that can arise in this location, capillary hemangioma and, but also from other mandibular tumors, such as ameloblastoma, which may cause inadequate resection of the lesion and recurrence of the tumor. We summarize the previous CHE cases and conclude the differences and similarities between the characteristics of CHE in other parts and CHE in oral cavity. And microscopically, CHE in this case consist with three different pathological features: spindle-cell hemangioma-like areas, retiform hemangioendothelioma-like areas and epithelioid hemangioendothelioma-like areas. Immunohistochemically, the tumor cells were positive for CD34, CD31, FLI-1 and D2-40. The expression of KI67 reached 50% in some regions and less than 10% in some regions, respectively. No recurrent disease was noted 40 months after the surgery. Therefore, we report a rare case of tumor in the mandibular ramus to increase the clinician's understanding of the maxillofacial CHE.