Extraconal cavernous hemangioma of orbit: A case report

Case report of cavernous haemangioma in the supraorbital region in the extraconal space: A rare location

Introduction

Cavernous haemangioma is the most common benign non-infiltrative neoplasm of the orbit. Most cavernous haemangiomas are intraconal and lateral in location.

Case report

We present a rare case of a cavernous haemangioma with an unusual location in the supraorbital region of the orbit, presenting with soft tissue swelling.

Discussion

Cavernous haemangiomas are the most common benign non-infiltrative neoplasms of the orbit and have a slowly progressive mass effect. A slowly progressive proptosis is the typical presenting symptom. Extraocular muscle impairment and impaired visual function are seen with large lesions and with lesions located at the orbital apex. Most cavernous haemangiomas are typically intraconal and lateral in location. Extraconal and medial locations are uncommon. Ultrasound, computed tomography and magnetic resonance imaging are useful imaging techniques for the evaluation of such tumours. Treatment of the tumour is surgical excision. Complete excision is generally accomplished as the tumour is well-encapsulated with relatively few feeding vessels.

Isolated cavernous venous malformation of the eyelid

Cavernous hemangioma, currently known as "cavernous venous malformation," is a common, benign, non-infiltrative, slowly progressive vascular malformation of the orbit presenting in adults. We report the case of a 9-year-old girl who presented with a painless palpable mass over the right upper eyelid of 7 years' duration. A computed tomography scan of the orbits revealed a heterogeneously enhancing, well-circumscribed mass in the right upper eyelid with no orbital extension. A transcutaneous excisional biopsy with histopathology disclosed cavernous venous malformation. The majority of cavernous venous malformations are intraconal and present in the fourth to fifth decade of life.

Unusual extraconal orbital location of a cavernous hemangioma

Cavernous hemangioma is the most common benign orbital and vascular tumor in adults. It is mostly located intraconally. Nevertheless, when the location is extraconal, the displacement of the globe is opposite the tumor's position. We describe an unusual presentation of this tumor in a 75-year-old female. The only symptom was the presence of epiphora. In the clinical examination, a mass was palpated on the lower orbital rim of the right eye. The magnetic resonance imaging (MRI) showed a well-circumscribed ovoid mass with a strong T2 hyperintensity and progressive contrast filling in T1. Excisional biopsy was performed, which confirmed the diagnosis of cavernous hemangioma. At five months of follow-up, there was no evidence of new symptoms.

Orbital Vascular Malformation

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Unusual Subcutaneous Presentation of Cavernous Hemangioma in the Lower Eyelid

Purpose

To report a patient with cavernous hemangioma (CH) presenting as a "subcutaneous" lower eyelid mass.

Case report

A 37-year-old man presented with a painless and palpable mass over the right lower eyelid for two years prior to referral. Computed tomography scan revealed a well-defined, lobulated mass located in the mid and lateral portion of the lower eyelid that extended posteriorly to the anterior orbital space. A transcutaneous excisional biopsy was performed. Histopathologic findings of the tumor confirmed CH. Most CHs are intraconal lesions, making our case an unusual presentation for this condition.

Conclusion

Purpose

Case report

CH may present superficially in the eyelid and anterior orbital area and thus, although this location is not common, it should be kept in mind as a differential diagnosis for any well-defined eyelid tumor.

Cavernous hemangioma of the orbit: an unusual acute presentation

We report an unusual presentation of an orbital cavernous hemangioma in a 26-year-old female, who noted sudden redness and swelling of the left eye (LE) on waking up. At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemorrhage were noted in the LE. Although there was transient symptomatic relief with topical medications, blurring of vision developed in the LE. When seen 10 days later, the patient’s LE showed axial proptosis. Magnetic resonance imaging revealed an intraconal soft tissue mass in the superomedial quadrant of the left orbit. Superior orbitotomy with mass excision was done; histopathological examination of the excised mass revealed a cavernous hemangioma. The patient had complete visual recovery following surgery. To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported.

VASCULAR ORBITAL TUMORS AT THE EXTREMES OF THE AGE SPECTRUM

Vascular orbital lesions are rare and, due to the controversy surrounding their origin, frequently difficult to diagnose. Studies showed that approximately 10% of orbital space-occupying lesions are of vascular origin. The most frequent are capillary hemangioma in children and cavernous hemangioma, which, although congenital, reveals itself in adults. Two cases of vascular tumors in patients, at the extremes of the age spectrum are presented.

Multiple cavernous haemangiomas of the the orbit and conjunctiva: A rare association

Cavernous haemangioma(CH) is mostly intraconal, single and unilateral in location. A 32 year old female presented with painless progressive growth near the inner canthus of right eye along with swelling of right upper eyelid and superomedial quadrant of the right orbit for five years. MRI showed lesions involving the preseptal space and extraconal compartment of the orbit at the superomedial aspect continous with the conjunctival swelling. Excision biopsy of the growths via anterior orbitotomy (vertical eyelid split technique) was done. Histopathological findings confirmed orbital cavernous haemangioma along with conjunctival CH.

We report a rare case of multiple cavernous haemangiomas arising from the conjunctiva as well as the superomedial orbit. Complete removal of the tumour is possible even in such difficult cases as the CH is totally encapsulated and meticulous surgical dissection can give good cosmetic result to the patient.