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Muhammed H, Diri D, Alasaad H, Mhana SAA, Ibrahim J. Intramuscular deep forearm hemangioma aggravated by a traumatic event: A case report. Int J Surg Case Rep 2023; 111:108869. [PMID: 37801961 PMCID: PMC10558304 DOI: 10.1016/j.ijscr.2023.108869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION Hemangioma is a unique benign vascular tumor. Intramuscular seated lesions tend to cause pain, swelling, and disability in adulthood, especially after a traumatic aggravating event. PRESENTATION OF CASE A young, healthy female suffered a previous trauma to her left forearm. Persistent pain developed after it with intermediate swelling that turned out to be a deep-seated hemangioma, which was treated successfully with excision. DISCUSSION Though it is often a benign-acting congenital lesion, with several treatment methods, early diagnosis of hemangioma is a dilemma. Expelling other similar malignant lesions is essential. Surgical intervention could be necessary and effective in specific indications. CONCLUSION Adequately planned surgery can successfully manage traumatic aggravated intramuscular hemangioma.
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Affiliation(s)
| | - Doried Diri
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Hakam Alasaad
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Jaber Ibrahim
- Faculty of Medicine, Damascus University, Damascus, Syria
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Zyluk A. Outcomes of Surgery for intramuscular Haemangiomas in the Extremities. HANDCHIR MIKROCHIR P 2022. [PMID: 35381601 DOI: 10.1055/a-1773-0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The objective of this case-series study was an assessment of outcomes of surgery for intramuscular haemangiomas in the extremities. PATIENTS AND METHODS Three women and one man with a mean age of 28 (23 - 34) years were operated on for intramuscular haemangiomas in the extremities, 3 in the forearms, and 1 in the calf. Three of them, 2 after resection of tumours from the forearm, and one after resection of the tumour in the calf, were available for follow-up assessment at an average of 1.5 (1 - 2) years after surgery. For patients with the tumour in the forearm, preoperative and at the follow-up examination pain was registered with use of the numeric rank scale (NRS), grip strength with the Jamar dynamometer, and function of the extremity with the quickDASH questionnaire. In the patient with the lower limb involvement, pain at the operation site, and efficiency (dexterity) of gait were evaluated. RESULTS All 3 patients with a follow-up examination reported significant reduction of pain. With regard to grip strength and hand function, one patient had significant improvement, whereas in the other, there were no real changes compared to preoperative. The patient with the calf involvement had no symptoms and walked normally. Over the follow-up period, no recurrence was noted. CONCLUSION The results of this small case-series study show that operative treatment of these rare tumours is safe and effective, however, it may be challenging in some cases.
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Lee HS, Hong YC, Jung KJ, Yeo ED, Won SH, Jang SH, Ji JY, Lee DW, Yoon SJ, Kim WJ. A Huge Plantar Intramuscular Hemangioma in the Plantar Area Treated Surgically: A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179088. [PMID: 34501676 PMCID: PMC8431436 DOI: 10.3390/ijerph18179088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
Intramuscular hemangioma (IH) is rare, accounting for only 0.8% of all hemangioma cases. In particular, IH of the foot has only been reported a few times. In such cases, the symptoms typically include tenderness and swelling, often in relation to physical activity, but tingling or impaired function may also be present. Here, we report a patient who presented with a significant IH in the plantar area treated surgically. A 25-year-old female visited our hospital with pain in the plantar aspect of the right foot. She had noticed a mass about 10 years prior. She had previously experienced pain only when pressing the mass, but the pain subsequently became more regular pain and was exacerbated by exercise. In fact, the pain became so intense that she could not sleep well. Upon physical examination, mild swelling and tenderness of the plantar area were noted in the second to the fourth metatarsal. Sensation and motor reflexes were normal and the results of Tinel’s test were negative. Plain radiographs of the right foot revealed phleboliths scattered throughout the first to third intermetatarsal spaces. Magnetic resonance imaging revealed a space-occupying multilobulated mass (5.6 × 2.8 × 2.5 cm) located in the flexor digitorum brevis (FDB) muscle, which penetrated the plantar fascia and spread to the subcutaneous layer. In T2-weighted images, the lesion displayed a hyperintense signal compared to the surrounding skeletal muscle. Based on radiological findings, we suspected IH. The mass surrounded by the FDB muscle was exposed and completely removed via wide excision. IH consisting of cavernous-like vascular structures was diagnosed on pathology. At 1-year follow-up, the patient was almost asymptomatic and had recovered almost full range of motion in the plantar area. Histological analysis and surgery are recommended to remove intramuscular hemangiomas in the plantar area, but if the patient is not suitable for surgery, sclerotherapy or combination treatment should also be considered.
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Affiliation(s)
- Hong Seop Lee
- Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea;
| | - Yong Cheol Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
| | - Eui Dong Yeo
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul 05368, Korea;
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea;
| | - Si-Hyong Jang
- Department of Pathology, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Jae Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea;
| | - Sung Joon Yoon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
- Correspondence:
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Intramuscular haemangioma of abductor hallucis muscle - A rare case report. Int J Surg Case Rep 2021; 77:682-685. [PMID: 33395873 PMCID: PMC7711174 DOI: 10.1016/j.ijscr.2020.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Haemangioma is a slow growing benign soft tissue tumor and its presentation in the foot is rare. Intramuscular haemangioma (IH) are usually found before 30 years of age, with gender predominance is still inconclusive. PRESENTATION OF CASE An 18-year-old woman came with pain and mass in the left foot for the past 3 years. Magnetic Resonance Imaging (MRI) of the left foot shown a heterogenous multilobulated mass, with previously thought originated from flexor digitorum brevis (FDB) muscle. Wide excision was performed and intraoperative findings showed that the mass actually originated from abductor hallucis muscle. Post-operative histopathological findings confirmed the diagnosis of cavernous-type of intramuscular haemangioma. DISCUSSION The rare occurrence of intramuscular haemangioma of the foot can cause a delayed diagnosis and treatment to the patient. The differential diagnosis include lipoma, fibroma, enlargement of the lymph nodes, compartment syndrome, hematoma, hernia, and soft-tissue sarcoma. Anytime a soft tissue mass is identified in the skeletal muscle of a young adult, haemangioma should be considered. CONCLUSION Literature research identified very few cases of intramuscular haemangioma of the foot. Wide excision of the muscle is a feasible surgical treatment option.
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DeGiovanni JC, Simmonds J, Lang-Orsini M, Lee A. Recurrent Intramuscular Hemangioma (Infiltrating Angiolipoma) of the Lower Lip: A Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2020; 101:306-311. [PMID: 32921186 DOI: 10.1177/0145561320957759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To report a case of a recurrent intramuscular hemangioma (IMH) of the lower lip of a 68-year-old female and review the published literature to provide an overview of the presentation, diagnostic strategy, pathological classification, and management of these lesions within the oral cavity. METHODS A case report was conducted by reviewing the documentation at a single institution. A systematic literature review on OVID MEDLINE and PubMed was performed using the MESH terms "intramuscular hemangioma" and "oral cavity," "tongue," "cheek," "buccal," "gingiva," and "lip." RESULTS A 62-year-old female presented to our institution with a 2 × 2 × 1 cm IMH of the lower lip involving the surrounding orbicularis oris muscle. She underwent a submucosal resection and did well postoperatively. Six and a half years later, she represented to our institution with a new lower lip lesion in the area of her previous resection. Preoperative magnetic resonance imaging showed a new 10 × 11 mm lesion with a well circumscribed central component surrounded by ill-defined tissue. Preoperative angiography showed that the lesion was supplied by vessels branching off the left facial artery, which were embolized. She underwent wide-local excision (WLE) with bilateral advancement flaps and at her 2-month postoperative visit has not had recurrence. CONCLUSION Only 39 cases of IMH in the oral cavity have been reported, with only 3 others occurring in the lower lip. Here we add the first case of an IMH of the oral cavity that recurred after primary WLE. The patient was successfully retreated with WLE. At a 3-month follow-up visit, she noted some incompetence with oral secretions and occasional tingling along the incision site but no evidence of recurrence.
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Affiliation(s)
| | | | | | - Arnold Lee
- Tufts University School of Medicine, Boston, MA, USA.,1867Tufts Medical Center, Boston, MA, USA
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Yu D, Choi JH, Jeon I. Intramuscular hemangioma with hemorrhagic transformation arising from paraspinal muscles of posterior neck: A case report. Medicine (Baltimore) 2020; 99:e21741. [PMID: 32872061 PMCID: PMC7437785 DOI: 10.1097/md.0000000000021741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Hemangiomas are usually found in cutaneous or mucosal layers, less than 1% of hemangiomas develop in skeletal muscles. Intramuscular hemangioma (IH) in the head and neck areas is relatively infrequent, accounting for 15% of IH. Most of them are identified as a benign mass, and rapid changes in size or internal bleeding are rare. PATIENT CONCERNS A 60-year-old female patient presented with a 2-week history of sudden onset posterior neck pain. There was no neurological deficit except limited neck motion due to pain. The palpable mass was noted on the paraspinal muscles of cervicothoracic junction, which was located midline to left side portion with tenderness. DIAGNOSES Magnetic resonance imaging demonstrated a round shaped, multi-lobulated, and well-defined mass lesion (4.1 × 2.6 × 0.9 cm) embedded from the inter-spinous space of T1-2 to the left paraspinal muscles. The lesion was iso-intense on T2-weighted images (WI), iso- to slightly low-intense on T1-WI, heterogeneous enhancement of intra- and peri-mass lesion on contrast-enhanced T1-WI. Vascular structures presented as signal voids were identified internally and around the mass lesion. Histological examination revealed a mixed-type hemangioma. INTERVENTIONS The mass was removed completely including some of the surrounding muscles where boundaries were unclear between the mass and surrounding muscles with ligation of peritumoral vessels. Dark-brown colored blood was drained from the ruptured tumor capsule during the dissection. There was no bony invasion. OUTCOMES The preoperative symptoms improved immediately after the operation. There is no residual or recurrence lesion by the 15-months follow-up. LESSONS IH with hemorrhagic transformation in the head and neck is extremely rare. In the case of intramuscular tumors accompanied by a sudden onset of severe acute pain, we recommend considering a differential diagnosis of IH with hemorrhagic transformation. Complete resection of the tumor mass including surrounding muscles is required to prevent recurrence.
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Affiliation(s)
| | - Joon Hyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
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Jamshidi K, Haji Agha Bozorgi M, Assad Kassir H, Mirzaei A. Surgical Excision as the First Therapeutic Choice in Single-muscle Hemangiomas: a Case Series. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:439-444. [PMID: 32766405 DOI: 10.22038/abjs.2019.40674.2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Conservative management is generally the primary treatment for intramuscular hemangimas. However, many patients will require surgery later in their life, after suffering a long period of pain. We aimed to evaluate the oncologic and functional outcomes of surgery as the initial treatment of single-muscle hemangiomas. Methods Medical profiles of 17 patients with hemangiomas of vastus medialis for whom surgery was selected as the initial treatment were reviewed. The indication for surgery was a bothersome pain. Postoperative muscle strength was assessed with manual muscle testing (range 0-5). The postoperative pain was measured by a visual analog scale (VAS) for pain (range 0-10). Lyshölm-Tegner knee scoring scale was used for the evaluation of knee function. Results The mean age of the patients was 25.9±8.6 years. Surgery was performed as wide resection in 13 cases and as marginal resection in 4 cases. At a mean follow-up of 55.76±30 months, two local recurrences (11.8%) were observed. At the last evaluation session, muscle strength grade was 5/5 in 13 patients and 4/5 in four patients. Postoperative pain was noticed in four patients (VAS=1). Knee function was excellent in 13 patients and good in four patients. Both of the local recurrences occurred in marginally resected lesions. Three out of four cases with reduced muscle strength, postoperative pain, and reduced function were also treated with marginal resection. Conclusion If a wide surgical margin is achievable without compromising the limb function, surgical resection could be considered as the primary choice of treatment for single-muscle hemangiomas.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Haji Agha Bozorgi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Assad Kassir
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Carabin J, Bouhamama A, Vaz G, Cuinet M, Ricoeur A, Thibaut A, Beji H, Mastier C, Pilleul F. Percutaneous Cryoablation of Symptomatic Intramuscular Venous Malformation. J Vasc Interv Radiol 2020; 31:558-563.e3. [PMID: 32113799 DOI: 10.1016/j.jvir.2019.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of cryoablation for venous malformations. MATERIALS AND METHODS A total of 12 patients with symptomatic intramuscular venous malformations who underwent percutaneous cryoablation between February 2015 and December 2018 were retrospectively studied. The mean age was 42 y (range, 19-58 y). Pain was reported by 11 patients (92%) and swelling by 1 (8%). Pain was assessed with a visual analog scale (VAS) before and after cryoablation. Lesion size was followed with magnetic resonance (MR) imaging at baseline and at 3-mo follow-up. Median initial VAS score was 7 (range, 0-8), and median initial lesion size was 32.5 mm (range, 11-150 mm). RESULTS The median VAS score at 3 mo was 0 (range, 0-4), and the median lesion size at 3 mo was 0 mm (range, 0-142 mm). Eleven of 12 patients reported an improvement in their pain. MR imaging control showed a treatment scar with no residual lesion in 5 patients and decreased lesion size in 4. No major complications were reported. One minor hematoma and 1 small myositis were noted as defined by Society of Interventional Radiology criteria. CONCLUSIONS Percutaneous cryoablation is effective and safe for treatment of symptomatic intramuscular venous malformations, with improvement of symptoms.
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Affiliation(s)
- Jonathan Carabin
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France.
| | - Amine Bouhamama
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Gualter Vaz
- Department of Orthopedic Surgery, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Marie Cuinet
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Antoine Thibaut
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Hedi Beji
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Frank Pilleul
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
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Kumar V, Mishra P. Intramuscular hemangioma of the forearm and phlebolith – A review of literature with case report. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joas.joas_19_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaur H, Tiwari P, Jha V, Bansal K. Intramuscular vascular malformation in triceps: A case report with literature review. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_80_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Intramuscular Hemangioma of the Forearm with Flexion Contracture. Case Rep Orthop 2019; 2019:6024039. [PMID: 31192019 PMCID: PMC6525862 DOI: 10.1155/2019/6024039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/14/2019] [Indexed: 11/17/2022] Open
Abstract
Intramuscular hemangiomas can be an infrequent but important cause of musculoskeletal pain. This report describes a 25-year-old male who presented with pain in the right forearm and contracture of the right hand for 4 years. Physical examination revealed severe tenderness of the midforearm with contracture of the flexor tendons in the index, middle, ring, and little fingers. Conventional radiography of the forearm revealed a soft tissue phlebolith. Magnetic resonance imaging showed a well-defined lobulated mass partially involving the FDP tendon. An intramuscular hemangioma within the deep anterior compartment of the forearm was suspected. Following surgical excision of the hemangioma, the patient's symptoms resolved completely. In conclusion, intramuscular hemangioma can be a rare cause of flexion contracture of the hands and should be considered as a cause of a flexion contracture that fails to respond to conservative treatment.
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Lahrach K, Abdulrazak S, Marzouki A, Boutayeb F. Surgical management of intramuscular hemangioma of the foot: a case report. Patient Saf Surg 2019; 13:17. [PMID: 30962823 PMCID: PMC6434622 DOI: 10.1186/s13037-019-0197-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hemangiomas are benign tumors usually found in the lower extremity yet their surgical management on the location in the foot is rarely documented. Case presentation We report a case of a plantar intramuscular hemangioma in 25-year-old patient with a history of percutaneous therapy. Patient had undergone intralesional sclerotherapy 3 years prior to his admission with persistent pain on weight bearing activities.MRI demonstrated a multi lobulated lesion of the 1st IMS with a peripheral enhancement on gadolinium injection. The patient underwent elective surgery with complete excision and no functional impairment at the last follow-up 3 years after surgery. Conclusion Intramuscular hemangiomas are rare occurrences. Steroid injection and sclerotherapy are effective non-operative methods. Complete excision of isolated hemangioma lesions allows definite diagnosis with no recurrence.
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Affiliation(s)
- K Lahrach
- Department of Trauma and Orthopedic Surgery A, Hassan II Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Atlas, Avenue Hassan II, 1835 Fès, BP 30000 Morocco
| | - S Abdulrazak
- Department of Trauma and Orthopedic Surgery A, Hassan II Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Atlas, Avenue Hassan II, 1835 Fès, BP 30000 Morocco
| | - A Marzouki
- Department of Trauma and Orthopedic Surgery A, Hassan II Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Atlas, Avenue Hassan II, 1835 Fès, BP 30000 Morocco
| | - F Boutayeb
- Department of Trauma and Orthopedic Surgery A, Hassan II Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Atlas, Avenue Hassan II, 1835 Fès, BP 30000 Morocco
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Liu Y, Li R, Liu Z, Wang S, Lu L. Intramuscular hemangioma within the biceps brachii causing the limitations of elbow extension and forearm pronation: A case report. Medicine (Baltimore) 2019; 98:e14343. [PMID: 30702620 PMCID: PMC6380852 DOI: 10.1097/md.0000000000014343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intramuscular hemangiomas are rare benign vascular neoplasms, merely accounting for 0.8% of all hemangiomas. Moreover, there are few case reports of intramuscular hemangiomas in the upper extremities. PATIENT CONCERNS A 24-year-old male patient presented with a 5-year history of intermittent pain of the right elbow joint. He had observed a swelling of the right cubital fossa over the past 2 years, leading to the limitations of elbow extension and forearm pronation. DIAGNOSIS The patient was diagnosed with intramuscular hemangioma of the biceps brachii. INTERVENTIONS Surgical excision of the tumor was performed for this patient and postoperative early functional exercises were permitted. OUTCOMES The movements of the right elbow and forearm reached the normal range of motion at 5 weeks after surgery. There was no evidence of recurrence during the 5-month follow-up. LESSONS Optimal management of intramuscular hemangioma is critical, including precise evaluation, good microsurgical technique and early functional exercises, which may result in a satisfying outcome.
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Sobh AH, Brown L, Moore DD. Intramuscular hemangioma after total hip arthroplasty: an iatrogenic etiology. Arthroplast Today 2018; 4:417-420. [PMID: 30569006 PMCID: PMC6287963 DOI: 10.1016/j.artd.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/01/2022] Open
Abstract
Soft-tissue hemangioma is a common benign tumor that can develop cutaneously, subcutaneously, or intramuscularly. Hemangioma formation within a muscular compartment is most often developmental in etiology; however, some cases are known to occur after blunt trauma to the soft tissues. To our knowledge, no cases of hemangioma formation after joint arthroplasty have been reported. We present a case of intramuscular hemangioma development within the hip abductor musculature after total hip arthroplasty via an anterolateral approach. Aside from developing congenitally or posttraumatically, hemangiomas may form after surgical dissection and must be considered as a source of anomalous swelling after surgery.
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Affiliation(s)
- Ali H. Sobh
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
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Dahmam A, Meyer zu Reckendorf G. Intramuscular hemangioma of the hypothenar eminence. A case report. HAND SURGERY & REHABILITATION 2017; 36:416-418. [DOI: 10.1016/j.hansur.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/30/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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Abstract
INTRODUCTION Intramuscular hemangioma (IMH) is a rare congenital soft tissue tumor. Here, we report a case of IMH patient who had undergone several surgeries and other treatments that were all ineffective before he visited us. CLINICAL FINDINGS This IMH patient was a 16-yearold male who was born with a tumor of unknown size in his right hand and forearm. On physical examination, the tumor and skin flap complex was seen with a size of 14 cm_12 cm in his right hand, and the multiple postoperative scars were shown on his right hand and forearm. The patient was not able to raise his right shoulder, and the ranges of motion of his right elbow, wrist, and finger were almost zero degrees. INTERVENTIONS Considering that the tumor had been surgically excised for several times and the multiple recurrences had affected adversely his daily life, an amputation of his right hand, forearm, and the part of his right arm was performed. DIAGNOSES The pathological examination confirmed the diagnosis of IMH. OUTCOMES After the amputation surgery, the patient gained a functional recovery and the tumor did not recur during the 2 years after the surgery. CONCLUSION A treatment of choice should be personalized according to an IMH patient's overall situation. For an IMH patient like our case with a history of multiple tumor recurrences, we suggest that an amputation surgery should be performed as early as possible to avoid the repeated, but ineffective surgical excisions and the unnecessary sufferings.
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Affiliation(s)
- Hui Lu
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
| | - Qiang Chen
- Department of Hand Surgery, Zhejiang Province People's Hospital, Hangzhou, Zhejiang Province, P. R. China
| | - Hu Yang
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
| | - Hui Shen
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
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Yu X, Nie T, Zhang B, Dai M, Liu H, Zou F. Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report. Oncol Lett 2016; 12:195-198. [PMID: 27347124 DOI: 10.3892/ol.2016.4610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/01/2016] [Indexed: 11/06/2022] Open
Abstract
Hemangioma is a common disease; however, intramuscular hemangioma (IH) presenting with a pathological fracture is extremely rare. The present study reports a case of a 46-year-old male patient that suffered from IH of the right thigh, presenting with a pathological femoral fracture. The patient was initially diagnosed with a traumatic femoral fracture, and routine open reduction and internal fixation were performed at a local hospital. However, 20 days subsequent to surgery, gradual swelling and soreness around the incision were observed. The incision eventually ruptured during squatting for bowel movement, which led to extensive blood loss. Based on computed tomography (CT) and deep femoral artery arteriography, IH presenting with a pathological femoral fracture was diagnosed. The patient underwent artery embolization, from which he recovered well. At the 6-month follow-up, the femoral fracture was revealed to have healed, and a CT scan demonstrated no evidence of recurrence; however, continuous observation using CT is required in order to determine the long-term outcome. To the best of our knowledge, this is the first case of a misdiagnosed pathological femoral fracture in a patient with IH reported in the English literature.
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Affiliation(s)
- Xiaolong Yu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Tao Nie
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Hucheng Liu
- Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Fan Zou
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
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Mautner KR, Sussman WI. Intramuscular vascular malformations: a rare cause of exertional leg pain and a novel treatment approach with ultrasound-guided doxycycline sclerotherapy. Am J Sports Med 2015; 43:729-33. [PMID: 25535098 DOI: 10.1177/0363546514561003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Walter I Sussman
- Center for Rehabilitation Medicine, Emory University, Atlanta, Georgia, USA
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19
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Lee KW, Lee HI, Kim CH, Kim TK. Large Cavernous Hemangioma of the Subscapularis Muscle - A Case Report. Clin Shoulder Elb 2014. [DOI: 10.5397/cise.2014.17.4.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Abstract
Haemangiomas are one of the most common benign tumours. Clinicians come across haemangiomas of different subtypes at different locations in the body. They are often faced with the question of whether to treat them or leave it to the natural history of the disease. We present a case of the intramuscular variety of haemangioma found in the unusual location of the tongue in a 60-year-old woman. Fine needle aspiration was inconclusive and on magnetic resonance imaging, it mimicked a malignancy, which prompted treatment. We also review the unique pathology of this variety of haemangioma, which defines their treatment. The radiological attributes of the disease and recurrence rates of surgery are also discussed.
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Affiliation(s)
- D Babu
- Tata Memorial Hospital, Mumbai, India
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21
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Uslu M, Beşir H, Turan H, Bozkaya H, Erdem H. Two different treatment options for intramuscular plantar hemangioma: surgery versus percutaneous sclerotherapy. J Foot Ankle Surg 2014; 53:759-62. [PMID: 25128310 DOI: 10.1053/j.jfas.2014.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Indexed: 02/03/2023]
Abstract
Intramuscular hemangiomas are benign neoplasms usually seen in children and adolescents. They tend to occur in the deep fascia and muscle and more often in the lower extremity, although they are rarely encountered in the plantar musculature. Surgical excision, ultrasound- or fluoroscopic-guided percutaneous sclerotherapy, and angiographic embolization are all treatment options. Surgical excision is the most prevalent form of therapy, although this can be difficult in the hands and feet. For this reason, ultrasound- and fluoroscopic-guided percutaneous sclerotherapy is a useful treatment option for pedal intramuscular hemangioma. In the present report, we describe 2 cases of intramuscular hemangioma in children, 1 treated by excision and 1 by percutaneous sclerosis.
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Affiliation(s)
- Mustafa Uslu
- Assistant Professor, Department of Orthopaedics and Traumatology, Düzce University School of Medicine, Düzce, Turkey.
| | - Halit Beşir
- Department of Radiology, Düzce University School of Medicine, Düzce, Turkey
| | - Hakan Turan
- Department of Dermatology, Düzce University School of Medicine, Düzce, Turkey
| | - Halil Bozkaya
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Havva Erdem
- Department of Pathology, Düzce University School of Medicine, Düzce, Turkey
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22
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Wierzbicki JM, Henderson JH, Scarborough MT, Bush CH, Reith JD, Clugston JR. Intramuscular hemangiomas. Sports Health 2014; 5:448-54. [PMID: 24427416 PMCID: PMC3752185 DOI: 10.1177/1941738112470910] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Intramuscular hemangiomas are common in the general population and often present at medical and surgical clinics. Unfortunately, unfamiliarity with these lesions has led to a high percentage of misdiagnoses, inappropriate workup, and unnecessary referrals. Evidence Acquisition: A literature search was performed using Medline, Embase, PubMed, and Cochrane. The relevant articles and referenced sources were reviewed for additional articles that discussed the epidemiology, pathophysiology, investigation, and management of intramuscular hemangiomas. Clinical experience from experts in orthopaedics, musculoskeletal pathology, and musculoskeletal radiology was compared. The selected case studies are shared cases of the authors. Results and Conclusion: The pathophysiology of these lesions is not completely understood, but much can be implied from their underlying vascular nature. Isolated lesions are benign tumors that never metastasize but tend to enlarge and then involute over time. Magnetic resonance imaging is the imaging modality of choice. If a systemic disorder or malignancy is not suspected or has been ruled out, conservative management is the treatment of choice for most intramuscular hemangiomas.
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Affiliation(s)
- Joseph M Wierzbicki
- Primary Care Sports Medicine Fellowship, Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Jeffrey H Henderson
- Primary Care Sports Medicine Fellowship, Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Mark T Scarborough
- Department of Orthopaedic Oncology, Orthopaedic and Sports Medicine Institute, University of Florida, Gainesville, Florida
| | - Charles H Bush
- Department of Radiology, University of Florida, Gainesville, Florida
| | - John D Reith
- Department of Pathology, Immunology, and Laboratory Medicine and the Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
| | - James R Clugston
- Primary Care Sports Medicine Fellowship, Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
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23
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Successful treatment of intramuscular venous malformation with image-guided radiofrequency ablation. J Vasc Interv Radiol 2013; 23:1391-3. [PMID: 22999762 DOI: 10.1016/j.jvir.2012.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 11/20/2022] Open
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24
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Effect of electrochemotherapy in treating patients with venous malformations. Chin J Integr Med 2013; 19:387-93. [DOI: 10.1007/s11655-013-1450-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Indexed: 10/27/2022]
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25
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Cho JH, Han I, Lee MR, Cho HS, Oh JH, Kim HS. Isolation and characterization of endothelial cells from intramuscular hemangioma. J Orthop Sci 2013; 18:137-44. [PMID: 22996814 DOI: 10.1007/s00776-012-0303-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/16/2012] [Indexed: 01/18/2023]
Abstract
BACKGROUND Intramuscular hemangiomas (IMHs) are benign vascular tumors of deep soft tissue characterized by endothelial cell (EC) proliferation. The purpose of this study was to isolate ECs from IMH, characterize their angiogenic phenotype and functional characteristics, and search for a possible signaling pathway related to IMH development. METHODS EC Isolation from IMH was performed by digestion, filtration, washing, incubation, and purification in sequence. Tie2 expression was compared between ECs from IMH and controls using reverse transcriptase polymerase chain reaction (RT-PCR). Cell invasion and proliferation assays were used to analyze functional responses of ECs to angiopoietin 1 (Ang1) and vascular endothelial growth factor (VEGF). Expression of downstream targets was analyzed using Western blot analysis. RESULTS Isolated ECs showed typical cobblestone appearance under light microscopy and formed capillary-like tubular structures using Matrigel tube-forming assay. RT-PCR of isolated ECs from six patients showed increased expression of Tie2 and VEGF receptor 1 (VEGFR1) compared with control ECs. Tie2 activation by Ang1 compared with VEGFR1 by VEGF resulted in increased EC migration and proliferation. Western blot analysis showed increased Tie2 expression in hemangioma samples compared with normal ECs. Phosphorylated Akt and phosphorylated forkhead box O1 (FOXO1) expression was observed in hemangioma samples only. CONCLUSION EC isolation from IMH could be a useful tool for further research. These results suggest that increased Tie2 expression, via Akt-FOXO1 pathway activation, may play an important role in IMH pathogenesis.
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MESH Headings
- Adolescent
- Adult
- Blotting, Western
- Cell Movement
- Cell Proliferation
- Child
- DNA, Neoplasm/genetics
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Female
- Gene Expression Regulation, Neoplastic
- Hemangioma/genetics
- Hemangioma/metabolism
- Hemangioma/pathology
- Humans
- Immunohistochemistry
- Male
- Muscle Neoplasms/genetics
- Muscle Neoplasms/metabolism
- Muscle Neoplasms/pathology
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/metabolism
- Neovascularization, Pathologic/pathology
- Receptor, TIE-2/biosynthesis
- Receptor, TIE-2/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction
- Tumor Cells, Cultured
- Young Adult
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Affiliation(s)
- Jae Hwan Cho
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno Gu, Seoul 110-744, Republic of Korea
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26
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Intractable pain due to rectus abdominis intramuscular haemangioma. Hernia 2012; 18:591-5. [PMID: 23263560 DOI: 10.1007/s10029-012-1024-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
Haemangiomas are tumours of vascular origin accounting for approximately 7 % of all benign tumours. Three types of haemangioma have been described according to the vessel type involved: capillary, cavernous and mixed. Intramuscular haemangiomas (IMHs) are infrequent, accounting for less than 1 % of all haemangiomas and are mostly located in the extremities and the trunk. Intramuscular haemangiomas of the rectus abdominis muscle are extremely rare, with only one previous case reported in the literature to the best of our knowledge. In this report, we present the case of a patient with intractable pain related to IMHs of the rectus abdominis and we analyse diagnostic assessment and surgical management of the condition.
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27
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Choi WH, Lee CJ, Oh SH, Chung BS, Rhim JK, Kwon KW. Cavernous hemangioma occurred between the trapezius and splenius capitis muscle. KOREAN JOURNAL OF SPINE 2012; 9:118-21. [PMID: 25983801 PMCID: PMC4432360 DOI: 10.14245/kjs.2012.9.2.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/05/2012] [Accepted: 06/25/2012] [Indexed: 11/19/2022]
Abstract
Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.
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Affiliation(s)
- Woo Hyung Choi
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Gyeonggi, Korea
| | - Chung Jae Lee
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Gyeonggi, Korea
| | - Sung Han Oh
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Gyeonggi, Korea
| | - Bong Sub Chung
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Gyeonggi, Korea
| | - Jong Kook Rhim
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Gyeonggi, Korea
| | - Kye Won Kwon
- Department of Pathology, Bundang Jesaeng General Hospital, Sungnam, Gyeonggi, Korea
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28
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Mitsionis GI, Pakos EE, Kosta P, Batistatou A, Beris A. Intramuscular hemangioma of the foot: A case report and review of the literature. Foot Ankle Surg 2010; 16:e27-9. [PMID: 20483123 DOI: 10.1016/j.fas.2009.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 05/17/2009] [Accepted: 05/23/2009] [Indexed: 02/04/2023]
Abstract
Intramuscular hemangiomas (IHs) are rare benign neoplasms usually seen in children, adolescents and young adults. Although lower extremities are the commonest localization, the localization at the foot is extremely rare since only a few cases have been reported. We report a case of mixed type IH of the flexor digitorum brevis muscle in a 12-year-old boy who was treated with surgical excision, with wide surgical margins.
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Affiliation(s)
- Gregory I Mitsionis
- The Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece.
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30
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Crawford EA, Slotcavage RL, King JJ, Lackman RD, Ogilvie CM. Ethanol sclerotherapy reduces pain in symptomatic musculoskeletal hemangiomas. Clin Orthop Relat Res 2009; 467:2955-61. [PMID: 19536604 PMCID: PMC2758985 DOI: 10.1007/s11999-009-0919-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 05/21/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Hemangiomas, benign vascular lesions, require intervention if causing pain or functional limitations. Functional deficits are common after excision, favoring minimally invasive treatments. To determine whether ethanol sclerotherapy reduces pain and lesion size and to assess complications in symptomatic musculoskeletal hemangiomas, we retrospectively reviewed 19 patients (six males, 13 females; mean age, 34 years) meeting criteria of confirmed hemangioma, treatment with ethanol sclerotherapy, and minimum of 6 weeks of followup. Fourteen were primary lesions and five were recurrent; all were painful. Thirty-eight sclerotherapy procedures were performed, with each patient undergoing a maximum of three procedures. Mean followup was 24 months (range, 2-95 months). Four patients reported full pain relief, 11 had partial relief, and four had no relief. With recurrent lesions, one patient had full pain relief, one had partial relief, and three had no relief. For patients with lesions larger than 5 cm, two had full relief, six had partial relief, and three had no relief. Lesion shrinkage occurred in 12 patients. Temporary complications included paresthesiae (three), tendon contracture (one), skin breakdown (one), and deep vein thrombosis (one). Ethanol sclerotherapy afforded prompt pain relief in 15 of 19 patients with hemangioma, making it a reasonable option for initially avoiding surgical excision. However, the short followup of our patients requires additional long-term studies to assess the duration of the results. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eileen A. Crawford
- Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 301 South 8th Street, Philadelphia, PA 19106-6192 USA
| | - Rachel L. Slotcavage
- Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 301 South 8th Street, Philadelphia, PA 19106-6192 USA
| | - Joseph J. King
- Department of Orthopaedic Surgery, Drexel University, Philadelphia, PA USA
| | - Richard D. Lackman
- Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 301 South 8th Street, Philadelphia, PA 19106-6192 USA
| | - Christian M. Ogilvie
- Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 301 South 8th Street, Philadelphia, PA 19106-6192 USA
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31
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Surgical outcome in patients treated for hemangioma during infancy, childhood, and adolescence: a retrospective review of 44 consecutive patients. J Pediatr Orthop 2008; 28:381-6. [PMID: 18362808 DOI: 10.1097/bpo.0b013e318168d1a7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hemangiomas are the most common tumors in infancy and childhood and account for 7% of benign soft tissue tumors. Diagnosis is usually made in infancy or childhood. There are only a few reports on the surgical treatment of these lesions, likely because the lesions are quite vascular, have a tendency to infiltrate into the muscle and other tissues, and the recurrence rate is quite high. METHODS We reviewed the outcome of surgical treatment on 44 consecutive children and adolescents with 47 surgically treated hemangiomas. Hemangiomas involving the face and the head were excluded. RESULTS Eleven lesions were surgically treated before the age of 5 years, 20 lesions between the ages of 5 and 12 years, and 16 lesions were treated after the age of 12 years. Eleven lesions had intralesional resection, 33 lesions underwent marginal resection, 2 lesions were managed with wide resection, and 1 lesion underwent radical resection. The overall recurrence rate was 22.2%. CONCLUSIONS In the pediatric population, it is desirable to perform definitive treatment whenever possible, thereby minimizing morbidity, both functional and psychological. Asymptomatic lesions should be monitored to confirm the diagnosis and to look for signs of progression. Symptomatic lesions can be treated with surgical excision if this does not result in significant functional impairment. A marginal resection may be used to treat most superficial soft tissue tumors. Intramuscular hemangiomas pose a more difficult therapeutic problem. When the lesion is limited in size, it may be treated with wide local excision. However, if the lesion is more diffusely spread into the muscle unit, the morbidity created by extensive muscle resection has to be weighed against the morbidity of the condition or alternative treatment methods. Whenever possible, a wide marginal resection should be carried out to minimize the risk of recurrence and avoid further surgical procedures. We recommend prolonged follow-up of these patients because 7% of the patients included in this study required late review due to multiple recurrences of these lesions. LEVEL OF EVIDENCE Level IV (case series).
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