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Oh J, Han SI, Lim SC. Intraosseous hemangioma with aneurysmal bone cyst-like changes of the hyoid bone: Case report and literature review. Medicine (Baltimore) 2024; 103:e37137. [PMID: 38335421 PMCID: PMC10860961 DOI: 10.1097/md.0000000000037137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE Intraosseous hemangioma is a rare benign vascular tumor of the bone that can affect any body part; however, the most common site is the vertebra, followed by calvarial bones. PATIENT CONCERNS We present a case of intraosseous hemangioma in a 23-year-old male who presented a feeling of fullness in the throat for 3 months. The hyoid bone level had a hard mass of about 5 cm. Fine needle aspiration showed 5 mL dark bloody aspirates. Magnetic resonance image showed a 5.3 cm mixed signal intensity lesion in the hyoid body. DIAGNOSIS Histopathologic examination showed intraosseous hemangioma with aneurysmal bone cyst (ABC)-like changes in the hyoid bone. INTERVENTIONS The mass was completely removed without significant problems. OUTCOMES Complete mass excision and symptomatic improvements were achieved, and no subsequent relapses were observed. LESSONS The authors experienced a case of intraosseous hemangioma with ABC-like changes. There has been no case report of intraosseous hemangioma in the hyoid bone. This case showed a spectral pattern of the ABC-like changes developing from the underlying bone tumor as a secondary change. ABC-like changes in bone tumors can mislead the diagnosis. Careful examination of the tumor is essential for the correct diagnosis of ABC or ABC-like changes.
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Affiliation(s)
- Jeonghyun Oh
- Department of Otorhinolaryngology, Chosun University, Gwangju, Korea
| | - Song Iy Han
- Division of Premedical Science, Chosun University, Gwangju, Korea
| | - Sung-Chul Lim
- Department of Pathology, College of Medicine, Chosun University, Gwangju, Korea
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Large Orbital Pediatric Intraosseous Hemangioma. Case Rep Ophthalmol Med 2020; 2020:5728691. [PMID: 31976106 PMCID: PMC6961600 DOI: 10.1155/2020/5728691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/19/2019] [Indexed: 11/17/2022] Open
Abstract
A five-year-old male presenting with progressive right facial swelling underwent multiple biopsies before being diagnosed with a polyostotic frontal-zygomatic primary intraosseous hemangioma. Intraosseous hemangiomas are rare, more frequently afflict adult females, and very rarely involve the orbit. Our case with bony destruction and surrounding soft tissue mass measured 5.3 cm in a child mimicked a more ominous malignancy. This case is unique with its rapid progression and largest reported size, leading to additional challenges such as difficulty in achieving an adequate tissue sample and in the surgical management with respect to significant blood loss in a small child.
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Temerek AT, Ali S, Shehab MF. Computer guided resection and reconstruction of intra-osseous zygomatic hemangioma: Case report and systematic review of literature. Int J Surg Case Rep 2019; 66:240-256. [PMID: 31874384 PMCID: PMC6931065 DOI: 10.1016/j.ijscr.2019.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/30/2019] [Accepted: 12/10/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES to systemically integrate the available data on various published treatment strategies for intraosseous hemangioma of the zygoma in an updated comprehensive systematic review, and to present a new case of treated resection and immediate reconstruction using computer guided patient specific composite graft. CASE PRESENTATION A 29 years old female patient with intraosseos zygomatic hemangioma treated using computer guided resection and immediate reconstruction. The resection was performed using a resection template constructed based on preoperative 3D planning. The reconstruction was performed using ramus bone graft and titanium mesh. The patient was followed up for 3 years with no complications. METHODS An electronic search was performed on 3 data bases; additional hand search of bibliographies of selected articles was performed. Eligibility criteria include human studies presenting intraosseous zygomatico-orbital hemangioma with clearly reported therapeutic strategies. RESULTS 53 articles with 73 cases were included. The lesion was highly prevalent in females compared to males (2.28:1). Fifth decade represents the highest prevalence with mean age of 44.1 ± 1.8 years. The main patient concern was swelling and facial deformity. Total tumor resection can assure no recurrence, while partial resection and curettage are associated with high recurrence rate.
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Affiliation(s)
- Ahmed Talaat Temerek
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, South Valley University, Qena, Egypt.
| | - Sherif Ali
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Mohamed Farid Shehab
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
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Abou-Al-Shaar H, Gozal YM, Hunt JP, Shelton C, Emerson LL, Joyce E, Couldwell WT. Multifocal cavernous hemangioma of the jugular foramen: a rare skull base vascular malformation. J Neurosurg 2019; 131:109-113. [PMID: 29979118 DOI: 10.3171/2018.1.jns172934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/19/2018] [Indexed: 11/06/2022]
Abstract
Jugular foramen cavernous hemangiomas are extremely rare vascular malformations, and, to the best of the authors' knowledge, their occurrence as multifocal lesions involving both intra- and extracranial compartments has never been reported before. Here, the authors describe the case of a 60-year-old woman with a complex multifocal jugular foramen cavernous hemangioma. The patient presented with signs and symptoms concerning for jugular foramen syndrome, as well as a right neck mass. Surgical extirpation of the lesion was achieved by a multidisciplinary team via a right infratemporal fossa approach (Fisch type A) with concurrent high neck dissection and a closure buttressed with an autologous fat graft and a temporoparietal fascial flap. Although rare, cavernous hemangiomas should be included in the differential diagnosis of jugular foramen masses.
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Affiliation(s)
| | - Yair M Gozal
- 1Department of Neurosurgery, Clinical Neurosciences Center
| | - Jason P Hunt
- 2Department of Otolaryngology-Head and Neck Surgery; and
| | - Clough Shelton
- 2Department of Otolaryngology-Head and Neck Surgery; and
| | - Lyska L Emerson
- 3Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Evan Joyce
- 1Department of Neurosurgery, Clinical Neurosciences Center
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Chandra SR, Chen E, Cousin T, Oda D. A case series of intraosseous hemangioma of the jaws: Various presentations of a rare entity. J Clin Exp Dent 2018; 9:e1366-e1370. [PMID: 29302291 PMCID: PMC5741852 DOI: 10.4317/jced.54285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/09/2017] [Indexed: 11/05/2022] Open
Abstract
Background Hemangiomas of the soft tissue are common in the head and neck area, especially in the tongue and in children under ten years of age. Intraosseous hemangiomas of the mandible and maxilla (IHM), on the other hand, are exceedingly rare and are not well characterized. This study presents six IHM cases focusing on the clinical, radiographic, and histologic characteristics. Material and Methods Six cases of IHM were retrieved from the archives of the Biopsy Services at the University of Washington. Clinical, radiologic, and histologic findings are described. Results A total of six cases of IHM were reviewed. The patient age range was 16 to 65; the group comprised three females and three males. All six cases presented as swellings, two caused tooth resorption, and one was associated with pain and numbness. Three of the six IHM were present in the body of the mandible, two in the area of the extracted right mandibular third molar, and one in the anterior maxilla between the right canine and lateral incisor. Radiographically, five were radiolucent and one was radiopaque. Of the five radiolucent, two were unilocular and three multilocular. The one radiopaque case was exophytic, simulating a large osteoma. Histologic features ranged from cavernous to a mix of venous and arterial types. Follow-up is available for all six cases ranging between one to seven years; only one case recurred within the first year post-surgery. Conclusions IHM are exceedingly rare; IHM do not present in a consistent manner both clinically and radiographically. It is therefore important to recognize the wide spectrum of IHM's clinical, radiographic, and histological presentations. Key words:Hemangioma, Vascular Malformation, mandible, maxilla.
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Affiliation(s)
- Srinivasa R Chandra
- MD, DDS, Clinical Assistant Professor, 1959 NE Pacific St, Department of Oral & Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington 98195-7133, USA
| | - Eleanor Chen
- MD, PhD, Assistant Professor, Department of Pathology, University of Washington Medical Center , 1959 NE Pacific St Box 357705
| | - Timothee Cousin
- DDS, Candidate, Class of 2017, 1959 NE Pacific St, Room D322, University of Washington School of Dentistry, Seattle, Washington 98195, USA
| | - Dolphine Oda
- BDS MSc, Professor, 1959 NE Pacific St, Department of Oral & Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington 98195-7133, USA
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Huang X, An J, Zhang Y, Cai Z. Intraosseous Venous Malformations of the Zygoma: Report of 4 Cases and Literature Review. Ann Otol Rhinol Laryngol 2017; 126:505-509. [PMID: 28376635 DOI: 10.1177/0003489417701934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES As intraosseous venous malformations (IVMs) of the zygoma are very rare and clinical features are not typical, a correct preoperative diagnosis may be difficult to make. This study presents 4 cases of IVM of the zygoma and gives a review of their clinical manifestations, radiographic features, preoperative diagnosis, and differentials. METHODS The report of 4 cases was performed with an average 6-year follow-up. Medical records including clinical, radiographic, and histopathological information were reviewed. RESULTS All the patients were mid-aged women with a complaint of an enlarging mass over the midface. They all failed to receive a definite preoperative diagnosis, and the diagnoses of IVM in all patients were made via pathological evidence. Although they received different surgical treatments, all the follow-up results (2~12 years) were satisfactory. CONCLUSION Intraosseous venous malformations of the zygoma are benign lesions caused by abnormal vessel morphogenesis. Patients usually present in their 40s with a tender or painless swelling of the zygoma. The key to the diagnosis is the typical sunburst pattern of radiating trabeculae with intact cortices on computed tomographic scans. Intraosseous venous malformations should be differentiated from other lesions, including intraosseous meningioma, fibrous dysplasia, osteochondroma, osteosarcoma, and ossifying fibroma.
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Affiliation(s)
- Xiuling Huang
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Jingang An
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Yi Zhang
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Zhigang Cai
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
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Powers DB, Fisher E, Erdmann D. Zygomatic Intraosseous Hemangioma: Case Report and Literature Review. Craniomaxillofac Trauma Reconstr 2016; 10:1-10. [PMID: 28210401 DOI: 10.1055/s-0036-1592087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/10/2016] [Indexed: 10/20/2022] Open
Abstract
Intraosseous hemangiomas are uncommon intrabony lesions, representing approximately 0.5 to 1% of all intraosseous tumors. Their description varies from "benign vasoformative neoplasms" to true hamartomatous proliferations of endothelial cells forming a vascular network with intermixed fibrous connective tissue stroma. These commonly present as a firm, painless swelling. Intraosseous hemangiomas present more commonly in females than in males and most likely occur in the fourth decade of life. The most common etiology of intraosseous hemangioma is believed to be prior trauma to the area. They have a tendency to bleed briskly upon removal or biopsy, making preoperative detection of the vascular nature of the lesion of significant importance. There are four variants: (1) capillary type, (2) cavernous type, (3) mixed variant, and (4) scirrhous type. Generally most common in the vertebral skeleton, they can also present in the calvarium and facial bones. In the head, the most common site is the parietal bone, followed by the mandible, and then malar and zygomatic regions. Intraosseous hemangiomas of the zygoma are rare entities with the first case reported in 1950 by Schoenfield. In this article, we review 49 case reports of intraosseous hemangioma of the zygoma, and also present a new case treated with excision followed by polyether-ether ketone implant placement for primary reconstruction.
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Affiliation(s)
- David B Powers
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elda Fisher
- Department of Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Detlev Erdmann
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Pediatric cranial intraosseous hemangiomas: a review. Neurosurg Rev 2016; 41:109-117. [DOI: 10.1007/s10143-016-0779-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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Matsumiya T, Nemoto H, Kasai Y, Maruyama N, Sumiya N. Intraosseous venous malformation of the zygoma: A case report and literature review. Int J Surg Case Rep 2015; 12:132-6. [PMID: 26072005 PMCID: PMC4485688 DOI: 10.1016/j.ijscr.2015.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/20/2015] [Accepted: 04/26/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Venous malformations of the zygoma are rare. Historically, venous malformations have been misrepresented as "hemangiomas". The International Society for the Study of Vascular Anomaly (ISSVA) classification is a reasonable classification that leads to appropriate clinical diagnosis and treatment strategies. Collaboration between surgeons, radiologists, and pathologists is necessary for accurate diagnosis and management. PRESENTATION OF CASE We present here a case of an IOVM in a 59-year-old woman who was treated with a multidisciplinary approach. Superselective arteriography and embolization were effective for diagnosis as well as for prevention of large hemorrhage during surgery. En-bloc resection of the zygoma was performed within hours after embolization and autologous calvarial bone graft was used for primary reconstruction. DISCUSSION We performed a literature review consisting of reviewing 52 cases of IOVM of the zygoma discussing optimal material for reconstruction of the defect for intraosseous venous malformation of the zygoma nationally and internationally. CONCLUSION The combination of surgery and preoperative angiography makes it possible to prevent high risk of hemorrhage. For primary reconstruction of the zygoma, use of autologous calvarial bone can maintain the volume and reconstruct the natural malar contour.
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Affiliation(s)
- Toshie Matsumiya
- Department of Plastic and Reconstructive Surgery of Fujigaoka Hospital of Showa University, 1-30 Fujigaoka, Aobaku, Yokohamashi, Kanagawa 227-8501, Japan.
| | - Hitoshi Nemoto
- Department of Plastic and Reconstructive Surgery of Fujigaoka Hospital of Showa University, 1-30 Fujigaoka, Aobaku, Yokohamashi, Kanagawa 227-8501, Japan
| | - Yoshiaki Kasai
- Department of Plastic and Reconstructive Surgery of Fujigaoka Hospital of Showa University, 1-30 Fujigaoka, Aobaku, Yokohamashi, Kanagawa 227-8501, Japan
| | - Naoki Maruyama
- Department of Plastic and Reconstructive Surgery of Fujigaoka Hospital of Showa University, 1-30 Fujigaoka, Aobaku, Yokohamashi, Kanagawa 227-8501, Japan
| | - Noriyoshi Sumiya
- Department of Plastic and Reconstructive Surgery of Fujigaoka Hospital of Showa University, 1-30 Fujigaoka, Aobaku, Yokohamashi, Kanagawa 227-8501, Japan
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Kadlub N, Dainese L, Coulomb-L'Hermine A, Galmiche L, Soupre V, Lepointe HD, Vazquez MP, Picard A. Intraosseous haemangioma: semantic and medical confusion. Int J Oral Maxillofac Surg 2015; 44:718-24. [PMID: 25703595 DOI: 10.1016/j.ijom.2015.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/20/2015] [Accepted: 01/29/2015] [Indexed: 01/18/2023]
Abstract
The literature is rich in case reports of intraosseous haemangioma, although most of these are actually cases of venous or capillary malformations. To illustrate this confusion in terminology, we present three cases of slow-flow vascular malformations misnamed as intraosseous haemangioma. A retrospective study of children diagnosed with intraosseous haemangioma was conducted. Clinical and radiological data were evaluated. Histopathological examinations and immunohistochemical studies were redone by three independent pathologists to classify the lesions according to the International Society for the Study of Vascular Anomalies (ISSVA) and World Health Organization (WHO) classifications. Three children who had presented with jaw haemangiomas were identified. Computed tomography scan patterns were not specific. All tumours were GLUT-1-negative and D2-40-negative. The lesions were classified as central haemangiomas according to the WHO, and as slow-flow malformations according to the ISSVA. The classification of vascular anomalies is based on clinical, radiological, and histological differences between vascular tumours and malformations. Based on this classification, the evolution of the lesion can be predicted and adequate treatment applied. The binary ISSVA classification is widely accepted and should be applied for all vascular lesions.
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Affiliation(s)
- N Kadlub
- APHP, Hôpital Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique Pédiatrique, Paris, France; Université Paris Descartes, Paris, France; INSERM, UMRS 1138, Oral and Molecular Pathology, Centre de Recherche des Cordeliers, 75006 Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France.
| | - L Dainese
- APHP, Hôpital d'Enfants Armand Trousseau, Service de Cytologie et Pathologie, Paris, France; Université Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - A Coulomb-L'Hermine
- APHP, Hôpital d'Enfants Armand Trousseau, Service de Cytologie et Pathologie, Paris, France; Université Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - L Galmiche
- Université Paris Descartes, Paris, France; APHP, Hôpital Necker Enfants Malades, Service de Cytologie et Pathologie, Paris, France
| | - V Soupre
- APHP, Hôpital Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique Pédiatrique, Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France
| | - H Ducou Lepointe
- Université Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France; APHP, Hôpital d'Enfants Armand Trousseau, Service d'Imagerie Médicale, Paris, France
| | - M-P Vazquez
- APHP, Hôpital Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique Pédiatrique, Paris, France; Université Paris Descartes, Paris, France; INSERM, UMRS 1138, Oral and Molecular Pathology, Centre de Recherche des Cordeliers, 75006 Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France
| | - A Picard
- APHP, Hôpital Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique Pédiatrique, Paris, France; Université Paris Descartes, Paris, France; INSERM, UMRS 1138, Oral and Molecular Pathology, Centre de Recherche des Cordeliers, 75006 Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France
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Werdich XQ, Jakobiec FA, Curtin HD, Fay A. A clinical, radiologic, and immunopathologic study of five periorbital intraosseous cavernous vascular malformations. Am J Ophthalmol 2014; 158:816-826.e1. [PMID: 25034115 DOI: 10.1016/j.ajo.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To correlate the clinical, radiographic, histopathologic, and immunohistochemical features of 5 primary periorbital intraosseous cavernous vascular malformations. DESIGN Retrospective interventional case series. METHODS Clinical and operative records and radiographic images were reviewed. Histopathologic slides were evaluated with hematoxylin-eosin, trichrome, and elastin stains. Immunohistochemical studies were performed with a spectrum of monoclonal antibodies directed at antigens of vascular cells. RESULTS Three men and 2 women ranged in age from 36 to 64 years. Vision was unaffected and there was no proptosis or globe displacement. The slow-growing lesions measured 13-25 mm in greatest diameter (mean 16.4 mm). Computed tomographic studies revealed that 2 lesions were situated in the maxillary bone, 2 in the frontal, and 1 in the zygoma, all anteriorly and with circumscribed, lucent, honeycombed, or sunburst characteristics. Histopathologically the lesions were composed of cavernous or telangiectatic channels; 1 showed advanced fibrotic vascular involution. Immunohistochemistry demonstrated CD31/34 positivity for vascular endothelium and D2-40 negativity for lymphatic endothelium. A typically thin mural myofibroblastic cuff was smooth muscle actin positive, weakly calponin positive, and desmin negative. Glucose transporter-1 and Ki-67 were negative in the endothelium. CONCLUSIONS Intraosseous vascular lesions resemble orbital cavernous venous malformations (not true hemangiomas), except that their vascular walls are thinner owing to the constraints imposed by neighboring bone spicules, which limit the amount of interstitium from which mural myofibroblasts can be recruited. The bony trabeculae conferred the honeycomb or sunburst appearances observed radiographically. En bloc excision of these lesions was successful and avoided complications (mean follow-up, 46 months).
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Affiliation(s)
- Xiang Q Werdich
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Hugh D Curtin
- Department of Radiology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Aaron Fay
- Ophthalmic Plastic Surgery, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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