Hemophilic pseudotumor of the inferior maxilla. Report of a case

Intraosseous venous malformation of the maxilla after enucleation of a hemophilic pseudotumor: A case report

BACKGROUND

Hemophilic pseudotumor (HP) is a rare complication in patients with hemophilia. The lesion most frequently occurs in the long bones, pelvis, small bones of the hands and feet, or rarely in the maxillofacial region. Postoperative changes in HP are seldom arrested, whereas angiogenesis characterized by disturbed wound healing in HP may cause vascular malformations.

CASE SUMMARY

We report the case of an 11-year-old boy who was affected by maxillary intraosseous venous malformation. Enucleation of an HP without factor replacement was performed initially on the right side of the maxilla 3 years ago. The patient was referred to us because of painless swelling in the same location. Factor replacement and subtotal maxillectomy were performed. Pathological examinations revealed intraosseous venous malformation.

CONCLUSION

This study is the first to document the development of intraosseous venous malformation after enucleation of an HP in the maxillofacial region. Angiogenesis characterized by disturbed wound healing in patients with hemophilia may be pivotal in the pathogenesis of this condition.

Haemophilic pseudotumour in two parts of the maxilla: case report

Haemophilic pseudotumour is a rare disease that occurs most often in femur, tibia, ilium or pelvic bone of a patient with haemophilia. Thus far, there have been only 31 reported cases in jaw bones and paranasal sinuses. Among them, the mandible is a more common site than the maxilla or paranasal sinuses. Here, we report a case of haemophilic pseudotumour in two parts of the maxilla. Contrast-enhanced CT showed an expansive and thinly corticated lesion with fluid attenuation at the left anterior maxilla which seemed like a post-operative maxillary cyst, ameloblastoma or odontogenic cyst. In addition, the thickened left palatal process of the maxilla seemed like fibrous dysplasia or intraosseous vascular malformation. Since haemophilic pseudotumour is not pathognomonic in radiological findings, when a patient who suffered from haemophilia or had taken anticoagulating agents has jaw lesion, haemophilic pseudotumour should be included in a differential diagnosis.

Pseudotumor of the mandible as first presentation of hemophilia in a 2-year-old male: a case report and review of jaw pseudotumors of hemophilia

Pseudotumor of hemophilia (PTH) is a rare complication seen in approximately 1-2% of cases of hemophilia. Although much more common in long bones, the pelvis, and small bones of the hands and feet than in the jaws, occasionally hemorrhage in the jaws occurs with this result. We present a case in a two-year-old male with a one-month swelling of the right mandible without significant medical history or diagnosis of hemophilia who was subsequently diagnosed as having Factor IX deficiency, or hemophilia B. A review of the literature revealed only 15 reported cases of PTH of the jaws and salient features of PTH in the jaws are discussed. The differential diagnosis of masses occurring in the jaws of children is limited and PTH should be considered when a mass presents with rapid growth and the histopathologic features are not diagnostic for a neoplastic process, even in the absence of a prior diagnosis of hemophilia as PTH may be the initial manifestation of this disease.

Haemophilic pseudotumour of the mandible: report of three cases

A haemophilic pseudotumour is basically an encapsulated haematoma. It is an infrequent complication, estimated to affect 1-2% of severe haemophiliacs, although it has also been reported in patients with mild and moderate haemophilia. A history of trauma is reported in most cases, and the onset of symptoms varies from months to years. The majority of haemophilic pseudotumours are seen in adults and occur in long bones (femur, pelvis, tibia). Here are reported three cases of pseudotumour of the mandible in young patients with mild haemophilia A.

Hemophilic pseudotumor of the jaws: report of two cases

Hemophilic pseudotumor of bone is a rare condition that occurs in patients with hemophilia. To date only 10 cases have been reported in the mandible, and none has been reported in the maxilla. The clinical, radiographic, and histologic features and treatment approaches of two cases of hemophilic pseudotumor occurring in the jaws are presented. One of them is probably the first one reported in the maxilla. Both patients had a history of trauma to the area.

Hemophilic pseudotumor: multicenter experience over a 25-year period

Pseudotumor is an infrequent manifestation of bleeding diathesis seen in hemophiliacs, the management of which is still controversial. To ascertain the effectiveness of the main therapies of choice, we have reviewed 1,831 patients affected by hemophilias A (1,108) and B (172), von Willebrand's disease (329), and other miscellaneous coagulopathies (222) diagnosed between 1965 and 1990 in a multicentric, retrospective study. Pseudotumor was proven in 21 patients. Replacement therapy was given in 15 cases as the first therapeutic approach, with complete success attained in only two, whereas surgery, which was carried out in 14 patients, completely resolved the process in eight (P = 0.017). Patients over 40 years of age demonstrated worse prognosis than younger patients (P = 0.02), but no other clinical parameters were shown to have influenced the patients' evolution. Surgical management was the most effective treatment for pseudotumor, although more conservative therapies cannot be overlooked in selected cases.

Radiotherapy of pseudotumors of bone in hemophiliacs with circulating inhibitors to factor VIII

Pseudotumors of bone in two hemophiliacs with severe factor VIII deficiency and a high level of circulating inhibitors are reported. Both had favorable response to radiation therapy after unsuccessful treatment with factor concentrates and remain free of recurrence at 18-62 months. A review of the literature of cases in which radiotherapy has been used is presented. Radiotherapy in the treatment of pseudotumors of bone in hemophiliacs should be strongly considered, particularly if coagulation factor inhibitors are present.

Hemophilic pseudotumor of the mandible. Report of a case

Hemophilic pseudotumor of bone is a rarely encountered lesion associated with hemophilia. To date, only eight cases in the mandible have been reported in the literature. A rare case occurring in the mandible of a 2 1/2-year-old child required the fabrication of a customized wound obturator for postoperative wound care after surgical curettage. The literature is reviewed and the obturator described.

Pseudotumor of hemophilia in the orbit: the role of radiotherapy in management

A case of pseudotumor of hemophilia is presented that occurred in the right orbit of a boy with severe factor VIII deficiency and an inhibitor. After a period of observation and conservative management, low-dose radiotherapy (750 rads) and Proplex was used. Eighteen months after radiotherapy significant healing had occurred. The role of radiotherapy in the treatment of hemophilic pseudotumor is reviewed.

Haemophilic pseudotumours of the mandible: report of a case in a one-year-old child

Pseudotumours of bone are an uncommon complication of severe haemophilia and only seven cases occurring in the mandible have been reported previously in the English literature. If treated early the condition appears to have a better prognosis and so it should be included in the differential diagnosis of any slowly progressive swelling of hard and soft tissues occurring in a patient with severe haemophilia. However aspiration and biopsy should be avoided if possible. Previous authors have advocated a variety of invasive procedures for this condition. A further case is described which is unique in the age at which the bilateral lesions developed, in the successful outcome of conservative management and in the dental observations.