Case 1

A 60-year-old man presented with a 3-year history of a solitary, bean-sized pulsatile nodule on his left nasolabial fold (Fig. 1A). He had basal cell carcinoma on the left side of the nasal ala which had been removed by an excisional operation in 2002. While excising the lesion, a pulsatile nodule had been found on the left nasolabial fold. It had been removed together with the basal cell carcinoma, and histopathologically was to be Monckeberg’s medial sclerosis. He had no history of other diseases such as diabetes mellitus or hyperten­sion and there were no abnormal results from the laboratory tests or physical examination. During the operation, the pusatile nodule turned out to be an inferior labial artery from the facial artery, and changed into a convoluted waxy-walled vessel (Fig. 1B). The surgeons cut both ends of the calcified lesion, and ligated each end of the vessel. The excised artery biopsy showed some discontinuous calcification on the media of the vessel (Fig. ЗА). A von Kosa stain showed medial calcification more clearly (Fig. 3B). We report that two years on from the operation, no sign of recurrence on the excised portion has been observed.

fig.1 solitary

Fig. 1. Solitary, non-tender, bean-sized pulsatile subcutaneous nodule on the left cheek in case 1 (A). The pulsatile nodule after skin incision revealing a convoluted waxy-walled artery (B).

fig.2 a solitary

Fig. 2. (A) Solitary, non-tender, bean-sized pulsatile subcutaneous nodule on the right cheek in case 2. (B) Ultrasonogram showing bented tubular blood flows in the subcutis.

Case 2

The second case was a 57-year-old woman who presented with a 2 year history of an asymptomatic, bean-sized pulsatile nodule on her right cheek (Fig. 2A). Authors could approach this patient’s disease more schematically because of the experience of case 1. No other diseases such as hypertension or diabetes mellitus was detected. There were also no occur­rences found on physical examination or from family history. She had an elevated ALP (283 U/L, normal 40-250 U/L), elevated total cholesterol (231 mg/dl, normal below 200 mg/dl), but other laboratory tests were within normal range. A color Doppler ultra­sonogram showed a convoluted tubular arterial flow under the right cheek (Fig. 2B), and a plain x-ray showed no calcified lesion on the skull, or on any other part of the body such as the upper and lower extremities, aortic arch or trunk. Even fundoscopy showed no abnormality. As in case 1, authors found out that the condition originated from the inferior labial artery and cut the calcified portion, ligating each end. Histopathological features resembled those of case 1 in H & E and the von Kossa stain (Fig. ЗА, 3B). In the 24 months since the mass was excised, no recurrence has been observed.  canadian antibiotics

fig.3 a excised