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A 31-year-old woman presented with a large oro-nasal communication (ONC), loss of vomer and significant nasal cartilage and nose deformity. Physical examination of the patient revealed a typical midline destructive lesion (MDL) with nasal septum and hard/soft palate perforation with a friable granular surface and a large amount of necrotic tissues. Medical history was unremarkable and the patient denied previous local trauma, including surgical procedures or drug assumption. Pathological examination revealed the presence of necrosis and chronic inflammation. MDLs have numerous etiologies. Signs and symptoms of MDLs can be similar and an accurate diagnosis may be elusive. We hereby present detailed clinicopathological findings. [ABSTRACT FROM AUTHOR]

Background Composite hemangioendothelioma is a rare histopathologic feature, which is part of the hemangioendothelioma family. This is a heterogeneous group of vascular neoplasiae with a high tendency to local relapse but a rare predisposition to metastatic spread. Composite hemangioendothelioma mainly affects adults and is usually localized in the distal extremity of the limbs. To date, only 1 case has been detected in the oral cavity. Methods A case of composite hemangioendothelioma in a 38-year-old man is reported. The lesion was localized in the left cheek vestibular mucosa. It was surgically excised with a 1-cm safety margin. Reconstruction was performed with a platysma myocutaneous flap. Results At present, the patient is free from recurrence. The aesthetic and functional outcomes are satisfactory. Conclusion This case demonstrates how a composite hemangioendothelioma histological diagnosis can be difficult to achieve. Furthermore, therapy must be surgical and excision should be wide. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]