Head and neck intramuscular haemangioma: report of two cases with unusual localization

Surgical management of intramuscular hemangioma of left masseter muscle: A case report

Hemangiomas are benign soft tissue tumors which are congenital and occur due to abnormal proliferations of blood vessels. Most common location of hemangiomas is subcutaneous adipose tissue, but skeletal muscle hemangiomas are very rare which make up to 0.8% of all hemangiomas. Usually, the intramuscular lesions are common in thigh region and calf muscles and are relatively rare in the facial muscles. Long-standing lesions results in phleboliths, and this may cause some symptoms. Conventional treatment of these isolated lesions may not yield satisfactory results. Hence, surgical excision of the lesion in toto results in aesthetically pleasing results with low chances of recurrence. In this article, we report a case of a left masseter intramuscular hemangioma in 19-year-old patient which was successfully managed by complete surgical excision.

An intramuscular hemangioma of the semispinalis muscle: A case report

Intramuscular hemangiomas are uncommon benign endotheliomas that typically occur in the trunk and limbs. Head and neck involvement is relatively infrequent, with the masseter muscle being the most commonly affected site. We present a rare case of intramuscular hemangiomas arising from the semispinalis muscle. A 31-year-old male presented with a painless swelling in the left upper neck region, gradually increasing in size over the past year. Imaging studies revealed a well-defined mass originating from the semispinalis muscle. Surgical excision was performed successfully, and histological examination confirmed the diagnosis of a mixed intramuscular hemangioma. The patient remained recurrence-free during the 2-year follow-up period. Intramuscular hemangiomas in the posterior neck muscles are rare, with only a few reported cases. Wide surgical resection with control of feeding vessels is the optimal treatment, and follow-up is recommended to monitor for local recurrence. This case report highlights the clinical presentation, diagnostic challenges, and successful surgical management of intramuscular hemangiomas in a unique location, emphasizing the importance of accurate diagnosis and appropriate treatment of this rare tumor.

The Challenges of Upper Extremity Intramuscular Hemangioma: a Case Study and Systematic Review

BACKGROUND

Intramuscular hemangiomas (IMHs) are rare, benign vascular tumors, comprising 0.8% of all hemangiomas. Upper extremity (UE) IMHs pose diagnostic and therapeutic challenges given their rarity, invasive nature, and potential for neurovascular involvement. We report a comprehensive systematic review of UE IMH management and a challenging case report.

METHODS

A systematic review was performed using PRISMA guidelines. Electronic databases were used to identify papers describing UE IMHs through 2019. Patient demographics, clinical presentation, management, complications, and outcomes were reviewed. Based on operative timing, cases were categorized as either "primary" (excision performed at initial diagnosis) or "secondary" (excision performed after failure of conservative treatment).

RESULTS

Eighteen articles encompassing 25 patients were included in our systematic review. Of those, 18 underwent primary excision and 7 underwent secondary excision. The majority involved the forearm or antecubital region. Complete excision, evaluated by gross examination or pathology, was reported in all primary cases and 71% secondary cases. Primary excisions demonstrated smaller mass size (19.4cm2 versus 165.3cm2) and superior reported functional outcomes (100% versus 33%). Complications were reported in 5% of the primary excisions compared to 71% of the secondary excisions, where 1 complication was a fatal hematoma.

CONCLUSION

The literature concerning UE IMH is limited to mostly case reports and several case series with the potential risk of bias. With careful dissection and microsurgical technique, wide local excision followed by complete reconstruction can be successfully performed at initial diagnosis for UE IMHs. At early stages, smaller lesion size significantly reduces the risk of functional impairment and complications.

An unusual location of a cavernous hemangioma: a case report

Hemangiomas are benign vascular tumors that most often affect the skin, mucous membranes, subcutaneous tissues, bone and on rare occasions muscles. In the head and neck region, the masseter and trapezius muscles are most often affected; the temporalis muscle involvement is extremely rare. It is a childhood pathology that rarely occurs in adults. We report a case of a cavernous hemangioma in a 37-year-old female. Through this case and in the light of literature we focus on the clinicopathological aspects of this tumor and the rarity of this location.

A rare case of intramuscular angioma involving the medial rectus muscle

Benign benign vascular tumors (e.g., hemangiomas) and malformations are commonly encountered lesions in all ages of life, especially in infancy and childhood. Hemangiomas are considered to be proliferative vascular lesions while malformations are defects of embryonal vascular morphogenesis. Less than 1% of hemangiomas within the body occur in skeletal muscle and of these approximately 15% have been reported to occur in the head and neck musculature (e.g. masseter, trapezius, sternocleidomastoid, mylohyoid, temporalis muscles) Intramuscular angioma (the preferred term for lesions formerly known as intramuscular hemangiomas by WHO Tumors of Soft Tissue and Bone Classification, 5th edition 2020) (IA) occurring in the extraocular muscles or palpebral muscles (orbicularis oculi) are extremely rare with only a few case reports in the English literature. To date, all the extraocular muscles have reportedly been involved. With the case reported herein, the medial rectus muscle appears to be the most common extraocular muscle involved.

Endoscope-Assisted Resection of Intramuscular Cavernous Hemangioma Within the Temporal Muscle

Hemangiomas are benign vascular soft tissue tumors, which most frequently occur in the skin or subcutaneous tissue. Intramuscular hemangiomas typically occur in the trunk and extremities and less frequently in the head and neck. Among these, those occurring in the temporalis muscle are extremely rare. The authors report the case of a 43-year-old Japanese male with a mass in his left temporal fossa. Computed tomography images showed no erosion of the zygomatic bone, and magnetic resonance imaging revealed an ovoid well-marginated mass within the temporal muscle. The lesion was surgically excised with an endoscopy procedure used for minimally invasive lesions and complete removal. Histopathological examination confirmed the diagnosis of intramuscular cavernous hemangioma. The postoperative clinical course was good, with no indications of temporary nerve paralysis. No signs of local recurrence were observed postoperatively. Therefore, a cavernous hemangioma should be suspected when a mass occurs in the temporal region with accompanying radiologic findings suggesting vascular origin. In surgical treatment, the endoscopy-assisted technique is very useful to achieve complete tumor resection and prevent relapse while avoiding serious complications due to surgical procedures.

A primary cavernous hemangioma of the thyroid gland: A case report and literature review

RATIONALE

Thyroid hemangioma is benign and associated with fine-needle aspiration (FNA) biopsy or trauma in most cases. Its differential diagnosis is very difficult.

PATIENT CONCERNS

We presented the case of a 48-year-old man complained of slowly progressed swelling in the anterior neck for 20 years.

DIAGNOSES

Ultrasound and CT scan revealed a hypoechogenic and heterogeneous mass measuring 4 × 3.5 cm located in the right lobe of thyroid gland. Postoperative pathological and immunohistochemical examinations of the surgical specimen revealed a primary hemangioma of the thyroid gland.

INTERVENTIONS

The patient received a right lobectomy of the thyroid.

OUTCOMES

The patient had been followed up for 10 months after surgery without complications and remained asymptomatic.

LESSONS

Primary thyroid hemangioma should be considered when there is a well-circumscribed capsule mass on medical imaging without history of FNA or any other cervical procedures or trauma.

Cavernous hemangiomas of the temporalis muscle with prominent formation of phleboliths: Case report and review of the literature

RATIONALE

Hemangiomas are benign tumors characterized by an abnormal proliferation of blood vessels, most often occur in the skin and subcutaneous tissue, intramuscular hemangioma, a distinctive type of hemangioma within the skeletal muscle, account for <1% of all hemangiomas, temporalis muscle is a very uncommon site, cavernous hemangioma of the temporalis muscle with prominent formation of phleboliths is rare reported.

PATIENT CONCERNS

A 62-year-old man presented with a slowly increased mass in his right temporal fossa.

DIAGNOSES

Computed tomography (CT) scan showed the lesion across the zygomatic arch, with many calcified nodules differ in sizes and no erosion to the bone, magnetic resonance imaging (MRI) showed an oval lesion with hypointense and isointense on T2-weighted imaging within the temporal muscle, and preoperation diagnosis was hemangioma.

INTERVENTIONS

The tumor was resected under general anesthesia.

OUTCOMES

The mass was excised completely, and the histopathology examination confirmed the diagnosis of cavernous hemangioma with prominent formation of phleboliths. The patient recovered very well without dysfunctions.

LESSONS

Cavernous hemangioma should be suspected when mass occurs in this region. CT and MRI are important for the early diagnosis of tumor, and resection the tumor completely is recommended.

Long-term effects of intracochlear electrical stimulation with looped patterns on tinnitus: A case study

Electrical stimulation by cochlear implant (CI) has been proven to be a viable treatment option for tinnitus in many recent studies. In addition, intracochlear electrical stimulation independent of an acoustic input appears to suppress tinnitus, at least in the short term. We conducted a case study to investigate the long-term effects of both standard CI and intracochlear electrical stimulation independent of an acoustic input on tinnitus in a patient with single-sided deafness and tinnitus. We found no negative effects of intracochlear electrical stimulation independent of an acoustic input on speech perception in noise. Furthermore, the additional use of a standard CI was advantageous for speech discrimination in our patient. We conclude that long-term tinnitus suppression can be achieved via intracochlear electrical stimulation with looped patterns. Our findings in terms of speech discrimination in our patient were consistent with those reported in previous studies.

Intramuscular Capillary Haemangioma of the Temporalis Muscle: A Rare Case with A Review of the Literature

An Intramuscular Haemangioma (IMH) is a benign mesenchymal tumour of the endothelial cells that accounts for less than 1% of all haemangiomas. Here we report the case of a capillary type intramuscular haemangioma in a five-year-old boy, only the fourth such case reported in literature, along with a relevant review of the literature. The lesion was surgically managed, with no recurrence in the follow up period till date.

Intramuscular Hemangioma of Thyrohyoid Muscle

Intramuscular hemangiomas are rare benign vascular neoplasms. IMH accounts for less than 1% of all hemangiomas. These neoplasms commonly occur in trunk and extremities but are rare in head and neck region. The present case is a 17-year-old female patient, who presented with a painless, slowly enlarging mass in left sided upper neck for 4 years. Investigations were suggestive of vascular neoplasm. She underwent excision of the mass in toto under general anesthesia. Postoperative period was uneventful. Histopathological examination of the mass revealed it as mixed type of intramuscular hemangioma. She did not have any signs of recurrences on her last follow-up at 6 months postoperatively. This case report discusses the rare IMH arising from thyrohyoid strap muscle.

Intramuscular Hemangioma: Enigmatic Dilemma in Diagnosis

Intramuscular hemangiomas (IMHs) occur when the proliferation of blood vessels is found between the skeletal muscle fibers, and they account for less than 1% of all hemangiomas. We report two cases of IMHs in the rare locations like tongue and temporalis muscle. These hemangiomas should be considered in a differential diagnosis of the soft tissue masses. Radiology plays a pivotal role in the diagnosis of these lesions.

How to cite this article

Kamra S, Pai KM, Chhaparwal Y. Intramuscular Hemangioma: Enigmatic Dilemma in Diagnosis. J Health Sci Res 2016;7(2):67-70.

Intramuscular Hemangioma in the Anterior Scalene Muscle Diagnosed by Core Needle Biopsy

Intramuscular hemangioma (IMH) is a rare, benign vascular lesion that frequently develops within skeletal muscles. Preoperatively, accurate diagnosis of IMH is often extremely difficult because of nonspecific clinical findings and the inaccuracy of fine-needle aspiration cytology. IMH is suspected in only 8% of preoperative diagnoses before surgical exploration. Here, we report a case of a 44-year-old man with a huge IMH in the anterior scalene muscle that was preoperatively diagnosed using ultrasonography-guided core needle biopsy, and was successfully treated based on preoperative clinical information.

An Intramuscular Hemangioma at the Cervical Muscle: A Case Report

Intramuscular hemangioma (IMH) primarily develops in the skeletal muscles of the limbs or trunk. The occurrence of IMH in the neck muscle is very rare. In the present report, we describe a case of IMH in the posterior neck muscle. A 58-year-old woman presented with a mass on the right posterior neck area, which had developed 2 years previously. The tumor was round in shape, had a size of 3.5×3.0 cm, and was fixed to the surrounding soft tissue. The patient complained of mild dull pain and tenderness at the mass without reddish discoloration. The mass showed a diurnal variation in size - the mass grew in size in the morning and became smaller in the afternoon. Preoperative study confirmed the vascular nature of the tumor. During peritumoral dissection, the mass shrank rapidly following profuse bleeding and arterial cauterization, and hence, it was difficult to distinguish the mass from the surrounding tissues. A total resection was possible with careful dissection of its fibrotic boundary. Based on the histological findings, a definitive diagnosis of cavernous type IMH was made. An initial suspicion of IMH, according to the clinical findings, would be helpful for decision making of further evaluations and surgical plan.

[Subglottic tracheal stenosis]

OBJECTIVES

To assess the results of endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy in the treatment of patients with symptomatic subglottic tracheal stenosis.

MATERIALS AND METHODS

Eleven patients (all female) with subglottic tracheal stenosis were divided into two groups: six patients with idiopathic subglottic tracheal stenosis and five with subglottic tracheal stenosis of known etiology (four with Wegener's disease and one with polychondritis of the trachea). Three patients showed signs of reflux. The primary outcome measure was improvement of the clinical symptoms and the secondary the postoperative reduction of airway resistance.

RESULTS

All patients were treated with CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy. Postoperative examinations during a period of 7 to 72 months demonstrated a reduction of symptoms and of airway resistance in all patients.

CONCLUSIONS

One or more endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy are effective in the treatment of subglottic tracheal stenoses. Long-term oral steroid and immunosuppressive therapy as well as the use of proton pump inhibitors positively influences the postoperative outcome.

Ultrasound-guided core-needle biopsy and magnetic resonance imaging in the accurate diagnosis of intramuscular haemangiomas of the head and neck

INTRODUCTION

Intramuscular haemangiomas of the digastric muscle are often misdiagnosed due to their low incidence and non-specific manifestation. Only two out of six previously reported cases were diagnosed correctly before excision. Ultrasound may not reveal their vascularity, and fine-needle aspiration biopsy is unhelpful as it reveals only blood.

METHODS

A case of intramuscular haemangioma of the posterior belly of the digastric muscle is described. Previously reported cases are reviewed. Investigations used to diagnose the lesions and reasons for their common failure are discussed.

RESULTS

Core-needle biopsy led to the correct histological diagnosis, and magnetic resonance imaging precisely located the lesion within the digastric muscle.

CONCLUSION

Core-needle biopsy was safely used in the diagnosis of an intramuscular haemangioma. The combination of core-needle biopsy and meticulous review of magnetic resonance imaging enables accurate diagnosis pre-operatively.

Intramuscular haemangioma of mylohyoid muscle: A case report

OBJECTIVE

To report a case of intramuscular haemangioma (IMH) with a rare presentation in the mylohyoid, with emphasis on the clinical appearance, and histologic characteristics of the lesion.

METHOD

Case report and review of the literature.

CONCLUSION

Neck swellings can often present a diagnostic dilemma, with a wide preoperative differential diagnosis. IMH are rare benign haemangiomas occurring within the skeletal muscle. They account for approximately 1% of all haemangiomas. These are uncommon in the head and neck region and occur most frequently in the trunk and extremities. In the head and neck, masseter and trapezius are the most common sites involved. Intramuscular haemangioma is seldom diagnosed preoperatively, perhaps due to unfamiliarity with this uncommon lesion and nonspecific clinical findings.

A Hemangioma on the Floor of the Mouth Presenting as a Ranula

A painless, bluish, submucosal swelling on one side of the floor of the mouth usually indicates the presence of a ranula. Rarely, such a swelling may be caused by an inflammatory disease process in a salivary gland, a neoplasm in the sublingual salivary gland, a lymphatic nodular swelling, or embryologic cysts. We report a patient with swelling in the floor of her mouth that was clinically diagnosed as a ranula. Suspicion arose during surgery that it was a vascular tumor and, on histologic testing, the swelling was confirmed to be a hemangioma. To our knowledge, this is the first report in the literature of a hemangioma presenting as ranula.

Intramuscular hemangioma of the retropharyngeal space

BACKGROUND

Intramuscular hemangioma (IMH) is a distinctive type of hemangioma occurring within skeletal muscle. Most IMH are located in the lower extremity, particularly in the muscles of the thigh. When present in the head and neck region, the masseter and trapezius muscle are the most frequently involved sites.

CASE REPORT

We reported a case of unusual localization of the head and neck IMH occurring within the retropharyngeal space (RPS). To our knowledge, this is the second such case reported in the English literature. The tumor presented as a left-sided neck mass with bulging of the posterior and left lateral oropharyngeal wall on indirect laryngoscopy. Computed tomography (CT) scan revealed an ill-defined mass in the RPS at the oropharyngeal level. The lesion was excised via a transoral approach and microscopically diagnosed as IMH, the complex malformation subtype. Although surgical margins were positive, no recurrence of the tumor was noted in the 17-month follow-up.

CONCLUSION

Intramuscular hemangioma should be considered in the differential diagnosis of deep head and neck masses. The knowledge of the infiltrative nature and recurrence rate of an IMH is useful for appropriate managment.

Modern Management of Laryngotracheal Stenosis

OBJECTIVES

Laryngotracheal stenosis is a complex problem resulting most often from intubation, trauma,or autoimmune disease. Management options include dilation or airway reconstruction including laryngotracheoplasty (LTP), cricotracheal resection (CTR), and tracheal resection (TR). We describe our experience with management of this difficult problem.

STUDY DESIGN

Retrospective chart review of patients treated for laryngotracheal stenosis between January 1995 and July 2005 at an academic, tertiary referral center.

METHODS

A total of 127 patients were treated during the study period. Patients were followed, and hospital records were reviewed.

RESULTS

There were 38 male and 89 female patients with an average age of 55.5 years treated for laryngotracheal stenosis resulting from intubation (64), idiopathic (25) or autoimmune disease (18), radiation (9), trauma (5), prior surgery (4), and relapsing polychondritis (2). Thirty-three percent were treated for grade I stenosis, 44% grade II, 19% grade III, and 4% grade IV. Seventy percent of patients undergoing initial dilation required a subsequent procedure. LTP, CTR, or TR was performed in 43%, 48%, 71%, and 100% of patients with grade I through IV stenosis, respectively. Among 76 patients undergoing LTP, CTR, or TR, 24 (32%) required a subsequent intervention. Among 36 patients treated with primary LTP, CTR, or TR, only 10 (28%) required further therapy. Twenty-two of 35 (63%) tracheostomy-dependent patients were ultimately decannulated. Three patients died in the immediate postoperative period.

CONCLUSIONS

Patients undergoing dilation for laryngotracheal stenosis require multiple procedures. However, major reconstructive procedures are well tolerated and currently represent a viable primary treatment for laryngotracheal stenosis.

Surgical management of laryngotracheal stenosis in adults

The purpose was to evaluate the outcome following the surgical management of a consecutive series of 26 adult patients with laryngotracheal stenosis of varied etiologies in a tertiary care center. Of the 83 patients who underwent surgery for laryngotracheal stenosis in the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Lausanne, Switzerland, between 1995 and 2003, 26 patients were adults (> or = 16 years) and formed the group that was the focus of this study. The stenosis involved the trachea (20), subglottis (1), subglottis and trachea (2), glottis and subglottis (1) and glottis, subglottis and trachea (2). The etiology of the stenosis was post-intubation injury ( n = 20), infiltration of the trachea by thyroid tumor ( n = 3), seeding from a laryngeal tumor at the site of the tracheostoma ( n = 1), idiopathic progressive subglottic stenosis ( n = 1) and external laryngeal trauma ( n = 1). Of the patients, 20 underwent tracheal resection and end-to-end anastomosis, and 5 patients had partial cricotracheal resection and thyrotracheal anastomosis. The length of resection varied from 1.5 to 6 cm, with a median length of 3.4 cm. Eighteen patients were extubated in the operating room, and six patients were extubated during a period of 12 to 72 h after surgery. Two patients were decannulated at 12 and 18 months, respectively. One patient, who developed anastomotic dehiscence 10 days after surgery, underwent revision surgery with a good outcome. On long-term outcome assessment, 15 patients achieved excellent results, 7 patients had a good result and 4 patients died of causes unrelated to surgery (mean follow-up period of 3.6 years). No patient showed evidence of restenosis. The excellent functional results of cricotracheal/tracheal resection and primary anastomosis in this series confirm the efficacy and reliability of this approach towards the management of laryngotracheal stenosis of varied etiologies. Similar to data in the literature, post-intubation injury was the leading cause of stenosis in our series. A resection length of up to 6 cm with laryngeal release procedures (when necessary) was found to be technically feasible.