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Almousa HM, Albesher MB, Alsolami AL, Al Mutairy AS. Intramuscular Hemangioma of the Sternocleidomastoid: A Rare Tumor in an Unusual Location. EAR, NOSE & THROAT JOURNAL 2023:1455613231189148. [PMID: 37644800 DOI: 10.1177/01455613231189148] [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: 08/31/2023] Open
Abstract
Intramuscular hemangiomas (IMH) are benign vascular tumors of the skeletal muscles. These tumors are uncommon in the head and neck region and usually affect the trunk and extremities. IMH of the masseter and trapezius muscles have been reported in the head and neck region. However, the sternocleidomastoid is extremely rare. In the current case report, we described a 25-year-old man with a rare case of intramuscular hemangioma involving the sternocleidomastoid muscle and reviewed the relevant literature. Contrast-enhanced computed tomography was initially obtained and showed a slightly hyperdense soft tissue mass. Head and neck magnetic resonance imaging (MRI) demonstrate a well-delineated hyperintense lesion on the T2 sequence suggestive of a soft tissue hemangioma. Subsequently, angioembolization using onyx was performed, followed by surgical excision of the mass under general anesthesia. Histopathological examination of the mass showed vascular proliferation within the skeletal muscles, and fatty tissue with an abundance of capillaries, which are consistent with capillary type intramuscular hemangioma. The patient was followed up in the clinic until the wound healed. Three months after surgery, no recurrence was observed. Preoperative angioembolization contributed to the success of IMH surgery by reducing morbidity, facilitating complete excision, and decreasing the risk of recurrence.
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Affiliation(s)
| | - Meshal B Albesher
- Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Afaf Lufayan Alsolami
- Department of central medical laboratory and blood bank (CML&BB), Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Alyaa S Al Mutairy
- Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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The Challenges of Upper Extremity Intramuscular Hemangioma: a Case Study and Systematic Review. Plast Reconstr Surg 2022; 150:367-376. [PMID: 35671450 DOI: 10.1097/prs.0000000000009324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Pirri C, Pirri N, De Caro R, Stecco C, Özçakar L. Ultrasound imaging as an initial diagnostic method for intramuscular hemangiomas: a narrative review. Postgrad Med 2022; 134:180-186. [PMID: 35076337 DOI: 10.1080/00325481.2022.2033562] [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: 01/19/2023]
Abstract
Intramuscular hemangiomas are benign vascular lesions, often misdiagnosed due to unfamiliarity. They are rare (but not very rare) causes of musculoskeletal pain and diagnosing these tumors may be challenging because of their pertinent non-specific symptomatology. Herein, as a convenient imaging tool, ultrasound examination appears to an important initial method to scan for these lesions after the clinical examination. To date, there are no studies that examined the state-of-the-art as regards the use of ultrasound imaging in the diagnosis of intramuscular hemangiomas. Accordingly, a literature search was performed using PubMed and Web of Science with the purpose to provide a conceptual understanding and awareness as regards the importance/utility of ultrasound imaging as a first step diagnostic tool for intramuscular hemangiomas at different muscles' locations.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Du J, Li K, Wang W, Jhonatan FY, Zhang W, Yang H, Huang L. Qualitative and quantitative diagnosis of intramuscular hemangioma subtypes: Diagnostic performance comparison of ESWAN and conventional MRI. Acta Radiol 2021; 64:208-216. [PMID: 34918569 DOI: 10.1177/02841851211065145] [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: 11/16/2022]
Abstract
BACKGROUND Preoperative identification of intramuscular hemangioma (IMH) subtypes (capillary hemangioma, cavernous hemangioma, and mixed hemangioma) is urgently necessary. Enhanced T2*-weighted angiography (ESWAN) is sensitive to vessels and metabolites and can be used to diagnose IMH subtypes. PURPOSE To compare the diagnostic performances of ESWAN and conventional magnetic resonance imaging (MRI) for qualitative and quantitative diagnosis of IMH subtypes. MATERIAL AND METHODS In total, 23 patients with IMHs were examined using conventional MRI and ESWAN. The signal intensity ratios (SIRs) of conventional MRI and ESWAN were measured. RESULTS There was no significant difference for volume among the three subtypes (P = 0.124, P = 0.145). Various shapes and MRI signals were shown in the three subtypes of IMH. There was no significant difference for SIRs of conventional MRI (P = 0.558, P = 0.259, P = 0.385, P = 0.347). However, there was a significant difference for SIRs of ESWAN parameters (P = 0.050, P < 0.001, P = 0.005, P = 0.002). Capillary hemangiomas can be diagnosed when R2* SIR is <0.912 and intratumoral susceptibility signal (ITSS) percentage is <29.085%. Cavernous hemangiomas should be considered when R2* SIR is >0.912, ITSS percentage >35.226%, and phase SIR >2.536. In addition, mixed hemangiomas should be considered when T2* SIR is >0.662 and R2* SIR <1.618. CONCLUSION Conventional MRI can only display the volume, shape, and signal of IMHs. 3D-MinIP imaging of ESWAN can show the veins and minor hemorrhage. SIRs of ESWAN parameters including T2* value, R2* value, phase value, and percentage of ITSS can be used to quantitatively diagnose capillary hemangiomas, cavernous hemangiomas, and mixed hemangiomas.
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Affiliation(s)
- Jun Du
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Department of Orthopedic Magnetic Resonance Chamber, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Kun Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Wei Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Felix Young Jhonatan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Weisheng Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Lixin Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
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Two Cases of Intramuscular Hemangiomas in the Upper Limbs: From Sonography to Pathology. Am J Phys Med Rehabil 2021; 100:e82-e84. [PMID: 33048488 DOI: 10.1097/phm.0000000000001561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Intramuscular hemangiomas are benign soft tissue tumors that are rarely found in the upper limbs. Diagnosing these tumors may be challenging owing to their pertinent nonspecific symptoms-often leading to misdiagnoses like tendinitis or muscle strain. In this article, two cases of intramuscular hemangiomas are presented-one in flexor pollicis brevis muscle and the other one in flexor digitorum superficialis muscle. Both subjects had nonspecific clinical symptoms whereby ultrasound imaging led to prompt diagnosis. To this end, the authors strongly advocate sonographic examination as an extension of physical examination in the daily clinical practice of musculoskeletal physicians.
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Wee SJ, Park MC, Chung CM, Tak SW. Intramuscular hemangioma in the zygomaticus minor muscle: a case report and literature review. Arch Craniofac Surg 2021; 22:115-118. [PMID: 33957738 PMCID: PMC8107454 DOI: 10.7181/acfs.2021.00087] [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: 03/15/2021] [Accepted: 04/20/2021] [Indexed: 02/03/2023] Open
Abstract
Intramuscular hemangioma is a rare vascular benign proliferation that can occur within any muscle, particularly in the trunk and extremities. In the head and neck region, the masseter muscle is most commonly involved, followed by the periorbital and sternocleidomastoid muscles. Diagnosing intramuscular hemangioma is challenging because there are no characteristic symptoms; instead, magnetic resonance imaging is the best imaging modality to diagnose these lesions. Complete surgical resection is the treatment of choice, although the local recurrence rate is high. Herein, we report a rare case of intramuscular hemangioma located in the zygomaticus minor muscle, which is related to smiling and usually runs along the orbicularis oculi muscle. Distinguishing or separating these two muscles is challenging. However, based on the muscle vector of the midface and radiological findings, the two muscles were successfully separated. The zygomaticus minor was cut very slightly to approach to the lesion and the muscle fibers were split to excise it. A follow-up examination revealed no nerve damage or muscle dysfunction at 4 weeks postoperatively. This rare case may serve as a reference for managing intramuscular hemangioma in the head and neck region.
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Affiliation(s)
- Sung Jae Wee
- Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Myong Chul Park
- Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Chan Min Chung
- Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seung Wan Tak
- TN Plastic and Reconstructive Surgery Clinic, Seoul, Korea
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Garefis K, Nikolaidis V, Kipriotou A, Tigkiropoulos K, Vlahodimos A, Markou K. A Rare Clinical Report of Intramuscular Hemangioma of the Middle Scalene Muscle. EAR, NOSE & THROAT JOURNAL 2021; 102:359-361. [PMID: 33784878 DOI: 10.1177/01455613211003834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intramuscular hemangioma (IMH) is an uncommon benign vascular lesion, which develops in skeletal muscles and it accounts for <1% of all hemangiomas. The accurate diagnosis is often difficult because the clinical and radiological findings are not specific. The gold standard treatment of IMH is surgical resection. We present a rare clinical report of IMH of the middle scalene muscle that was treated successfully with preoparative embolization and surgical excision.
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Affiliation(s)
- Konstantinos Garefis
- 2nd Academic ORL, Head and Neck Surgery Department Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Vasilios Nikolaidis
- 2nd Academic ORL, Head and Neck Surgery Department Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Anastasia Kipriotou
- 2nd Academic ORL, Head and Neck Surgery Department Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Konstantinos Tigkiropoulos
- Vascular Unit, 1st Academic Surgical Department Aristotle of University, Papageorgiou Hospital, Thessaloniki, Greece
| | | | - Konstantinos Markou
- 2nd Academic ORL, Head and Neck Surgery Department Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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Yao TH, Pataer P, Regmi KP, Gu XW, Li QY, Du JT, Ge SM, Tu JB. Propranolol induces hemangioma endothelial cell apoptosis via a p53‑BAX mediated pathway. Mol Med Rep 2018; 18:684-694. [PMID: 29767244 PMCID: PMC6059697 DOI: 10.3892/mmr.2018.9013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 12/01/2017] [Indexed: 12/11/2022] Open
Abstract
The use of propranolol for the treatment of infantile hemangioma (IH) has been widely investigated in recent years. However, the underlying therapeutic mechanism of propranolol for the treatment of IH remains poorly understood. The aim of the present study was to investigate the expression of proteins regulated by cellular tumor antigen p53 (p53) in associated apoptosis pathways in IH endothelial cells (HemECs) treated with propranolol. Furthermore, the present study aimed to investigate the exact apoptotic pathway underlying the therapeutic effect of propranolol against IH. In the present study, HemECs were subcultured and investigated using an inverted phase contrast microscope, immunocytochemical staining and a scanning electron microscope (SEM). Experimental groups and blank control groups were prepared. All groups were subjected to drug treatment. A high p53 expression model of HemECs was successfully established via transfection, and a low p53 expression model of HemECs was established using pifithrin-α. The apoptosis rate of each group was determined using Annexin V-fluorescein isothiocyanate/propidium iodide double staining and flow cytometry. The expression levels of downstream proteins regulated by p53 [tumour necrosis factor receptor superfamily member 6 (FAS), p53-induced death domain-containing protein (PIDD), death receptor 5 (DR5), BH3-interacting domain death agonist (BID), apoptosis regulator BAX (BAX), p53 unregulated modulator of apoptosis (PUMA), phosphatidylinositol-glycan biosynthesis class S protein (PIGS), and insulin-like growth factor-binding protein 3 (IGF-BP3)] were revealed in the experimental and control groups via western blotting. Microscopic observation revealed the growth of an adherent monolayer of cells, which were closely packed and exhibited contact inhibition. Immunocytochemical staining demonstrated increased expression of clotting factor VIII. SEM analysis revealed presence of Weibel-Palade bodies. The results of the analyses verified that the cultured cells were HemECs. The staining of the samples resulted in a significantly increased rate of apoptosis in experimental groups compared with the blank control group. This result suggested that there is an association between p53 expression and the rate of apoptosis of propranolol-treated HemECs. The results of the western blot analysis demonstrated an upregulation of BAX expression and a downregulation of IGF-BP3 expression in the HemECs treated with propranolol. There were no significant differences in the expression levels of FAS, DR5, PIDD, BID, PUMA and PIGS between experimental and control groups. This result suggests that p53 has an important role in HemEC apoptosis. The results of the present study additionally suggest that the propranolol-induced HemEC apoptosis pathway is a mitochondrial apoptosis pathway and is regulated by p53-BAX signaling.
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Affiliation(s)
- Tian-Hua Yao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Parekejiang Pataer
- Oncology Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Krishna Prasad Regmi
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Xi-Wen Gu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Quan-Yan Li
- Stomatological Hospital of Tai'an, Tai'an, Shandong 271000, P.R. China
| | - Jing-Ting Du
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Su-Meng Ge
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Jun-Bo Tu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
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Öztürk E, Yılmaz E, Öztürk İE, Polat B, Orhan KS. Posttraumatic Intramuscular Hemangioma Arising from Scalene Muscles in Supraclavicular Region. Turk Arch Otorhinolaryngol 2017; 55:87-90. [PMID: 29392062 DOI: 10.5152/tao.2017.2138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/28/2017] [Indexed: 11/22/2022] Open
Abstract
Intramuscular hemangiomas (IMH) account for <%1 of all hemangiomas and are rarely located in the head and neck region. The most common site of origin in the head and neck is the masseter muscle, whereas IMH originating from the scalene muscles are rarely seen. Surgical excision of intramuscular hemangioma is considered the main treatment modality. Here we present the case of a male patient aged 17 with IMH that occured after blunt trauma in the supraclavicular region, fed by the thyrocervical and costocervical trunks, and with an arteriovenous shunt.
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Affiliation(s)
- Erkan Öztürk
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Eren Yılmaz
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - İlker Erdinç Öztürk
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Beldan Polat
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Kadir Serkan Orhan
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Arts RA, George EL, Griessner A, Zierhofer C, Stokroos RJ. Long-term effects of intracochlear electrical stimulation with looped patterns on tinnitus: A case study. EAR, NOSE & THROAT JOURNAL 2017; 95:E9-E15. [PMID: 27140029 DOI: 10.1177/014556131609504-505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Remo A Arts
- Department of ENT/Head and Neck Surgery, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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