Head and Neck Pathol (2009) 3:54–58 On examination, a diffuse swelling in the right side of the face extending from the ala-tragal plane superiorly to the lower border of mandible, from the anterior to posterior border of masseter, was seen. Skin overlying the swelling was normal in color and texture. Intraorally, bluish discolouration of the right buccal mucosa with telengiectasia or spider nevi appearance was evident (Fig. 1a). On palpation the swelling was non ten- der, collapsible on digital pressure and ﬁlled up on releasing the pressure. The submandibular lymph nodes were palpable bilaterally. The orthopantamogram (OPG) showed calciﬁed scat- tered masses lateral to the right ramus of the mandible (Fig. 1b). Ultrasonography revealed the presence of hypoechoic areas showing the distorted ﬁbers of the mas- seter muscle and hyperechoic areas showing phleboliths. Thus a provisional diagnosis of hemangioma was considered. Excision was done under general anesthesia and opera- tive ﬁndings presented the buccal pad of fat inﬁltrated with vascular tissues and involving the right masseter muscle. Gross specimen showed soft tissues which were black in color with a few calciﬁed masses (possibly phleboliths). The microscopic ﬁndings revealed disorganized prolif- eration and randomly arranged blood vessels of varying sizes in between muscle bundles; endothelial proliferation and canalization was also seen (Fig. 1c, d). An extensive area of hemorrhage was evident and so were calciﬁcation depicting phleboliths. Based on clinical, radiological and histopathological ﬁndings, a diagnosis of angiomatosis was derived. Fig. 1 a Lesion seen on buccal mucosa, b small opacities depicting phleboliths, c proliferating vessels inﬁltrating in between the muscle bundles, d dilated thick walled vessel between the muscle bundles 55 Case 2 A 19-year-old female presented with a chief complaint of swelling in left side of the face since 3–4 years. On examination, a well circumscribed solitary swelling of the left malar region was seen which measured approximately 3 9 3 cm2 (Fig. 2a). The overlying skin was normal, soft and non-tender on palpation. Radiographically, no signiﬁ- cant ﬁndings were seen and a provisional diagnosis of lipoma was considered. Excision was done under general anesthesia. Gross specimen showed soft tissue mass ﬂoating in formalin, with irregular borders and white to brownish in color (Fig. 2b). Microscopically the excised specimen revealed blood vessels of varying caliber inﬁltrating into to the stroma rich in adipose tissue (Fig. 2c). Few areas showed small pro- liferating capillaries adjacent to major feeder vessels (Fig. 2d) and areas of canalization and new blood vessel formation were also evident (Fig. 2e). Nerve bundles too, were inﬁltrated by proliferating blood vessels (Fig. 2f), prompting a ﬁnal diagnosis of angiomatosis. Case 3 A 16-year-old male presented with the chief complaint of swelling on lower right region of the jaw since 2 months. The swelling had gradually progressed in size and pro- duced mild pain on mastication. The lesion presented with facial asymmetry at the lower third of the face, with bony hard swelling extending from the symphysis to angle of the mandible (Fig. 3a). The swelling was tender on palpation.