Hemangioma

Pedunculated cavernous hemangioma originating in the olfactory cleft

September 17, 2014     Kaiming Su, MD, PhD; Weitian Zhang, MD, PhD; Haibo Shi, MD, PhD; Shankai Yin, MD, PhD
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Abstract

Sinonasal cavernous hemangioma is a rare condition that usually affects the lateral wall of the nasal cavity. We report the case of a 77-year-old man who presented with severe epistaxis, nasal congestion, and olfactory dysfunction. Endoscopic examination of the nasal cavity revealed the presence of a red-blue tumor that had almost completely filled the nasopharynx. Preoperatively, it was difficult to distinguish this lesion from a juvenile nasopharyngeal angiofibroma. During endoscopic surgery, the tumor was found to originate in the left olfactory cleft, and it had a long peduncle that contained blood vessels. Postoperative histopathologic examination indicated that the mass was a cavernous hemangioma. To the best of our knowledge, this is the first case of an olfactory cleft cavernous hemangioma and the first case of olfactory cleft disease associated with a cavernous hemangioma to be reported in the English-language literature.

An unusual cause of dyspnea in a pregnant woman: Supraglottic hemangioma

August 27, 2014     Zehra Kurdoglu, MD; Mertihan Kurdoglu, MD; Hakan Cankaya, MD
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Abstract

Dyspnea is a common complaint among pregnant women; upper airway obstruction is a rare cause of it. We report a case of supraglottic hemangioma in a 20-year-old pregnant woman who presented with increasing dyspnea and hoarseness at 40 weeks of gestation. She gave birth to a healthy 3,100-g girl by caesarean delivery under epidural anesthesia. She was able to breathe easily during the postpartum period. This case represents a rare instance of dyspnea caused by a supraglottic hemangioma in a pregnant woman.

Diffuse sphenoid bone cavernous hemangioma presenting during pregnancy

October 23, 2013     Hugh Robertson, MD, FACR; Enrique Palacios, MD, FACR; Sheryl Rincon, MD; Kamal R. Shah, MD
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Abstract

We present a case of diffuse sphenoid bone cavernous hemangioma in a 22-year-old primigravid woman. Her disease first manifested clinically as progressively decreasing vision in her left eye during her third trimester of pregnancy. We also discuss the known causes and some theoretical causes of cavernous hemangioma enlargement during pregnancy.

Kasabach-Merritt syndrome in a child with upper airway compromise and spontaneous periorbital bruising

June 11, 2013     Jay Goswamy, MRCS, DOHNS; Rohini Aggarwal, FRCS(ORL-HNS); Iain A. Bruce, MD, FRCS(ORL-HNS); and Michael P. Rothera, FRCS
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Abstract

A hemangioma that rapidly increases in size has the potential to trap platelets and cause a consumptive coagulopathy. We describe the case of an 18-week-old boy who was brought to a local emergency department with ecchymosis on his nasal bridge and medial epicanthi, as well as a subconjunctival hemorrhage. He was noted to be anemic and thrombocytopenic. Packed red blood cells and platelets were transfused. However, despite hematologic correction, the ecchymosis and petechiae worsened, and a mass became evident in the right posterior triangle of the patient's neck. Computed tomography demonstrated a lobular soft-tissue-density mass in the right posterior triangle that extended to the level of the skull base. Histologic analysis of a biopsy specimen revealed that the lesion was a giant kaposiform hemangioma. The patient was diagnosed with Kasabach-Merritt syndrome, and prednisolone was commenced as a first-line treatment. However, the mass continued to grow, resulting in inspiratory stridor. Magnetic resonance imaging revealed encroachment into the thecal sac and compression of the spinal cord. The lesion was embolized, and vincristine therapy was commenced. Following a second embolization, the size of the lesion decreased and no further blood products were required. The hemangioma was deemed to be unresectable. The successful treatment in this case was dependent on the maintenance of hemostasis, the initial medical treatment with a corticosteroid, repeat embolization, and longer-term control with vincristine.

Cavernous hemangioma of the external auditory canal

April 17, 2013     Min-Tsan Shu, MD; Kang-Chao Wu, MD; Yu-Chun Chen, MD
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The differential diagnosisfor cavernous hemangioma of the external auditory canal includes attic cholesteatoma with aural polyp, glomus tumor, arteriovenous malformation, granulation tissue, and carcinoma of the EAC.

Propranolol in the treatment of upper airway hemangiomas

April 17, 2013     Lauren C. Anderson de Moreno, MD; Bruce H. Matt, MD; Gregory Montgomery, MD; Young-Jee Kim, MD
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Abstract

Airway hemangiomas (AHs), which are common in infant airways, often cause significant upper airway obstruction. The various therapies used for AH have limitations and complications. Propranolol may have a potential role in its treatment, since it leads to regression or stabilization of cutaneous infantile hemangiomas. To date, only 4 previous case reports (7 patients) in which propranolol was used for AH have been published. Based on encouraging preliminary data on propranolol use for AH treatment, our goal was to further investigate propranolol as an effective initial treatment of upper AHs that cause significant obstruction symptoms. In this retrospective case series, we reviewed the medical records of 5 consecutive pediatric patients with AH (glottic and subglottic) treated with propranolol at a tertiary care children's hospital. All 5 patients were 2 months of age at the time of hemangioma diagnosis and had stridor and physical signs of severe upper airway obstruction. Hemangioma was diagnosed by flexible laryngoscopy or flexible bronchoscopy. All patients received propranolol 2 mg/kg/day and showed significant relief of obstruction symptoms within 24 hours of treatment initiation. All patients tolerated propranolol without significant cardiovascular complications. Outcomes from this case series, in conjunction with available case reports in the literature, suggest that propranolol is a safe initial treatment for symptomatic upper AH.

Development of hemangioma in a tongue harboring long-standing angiokeratoma circumscriptum

October 31, 2012     J. Madana, MS, DNB; Deeke Yolmo, MS; S. Gopalakrishnan, MS; Sunil Kumar Saxena, MS
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Abstract

Angiokeratoma is a very rare vascular lesion of the papillary dermis. It is characterized by vascular ectasia with overlying epidermal hyperkeratosis. The systemic form of angiokeratoma is associated with Fabry disease and fucosidosis. There are several localized forms. Tongue involvement is uncommon. Hemangiomas are tumors made up of capillaries; they grow by active endothelial proliferation as opposed to expansion of vascular spaces in vascular malformations. Lingual hemangiomas are usually indolent, but they can cause cosmetic deformities, recurrent hemorrhage, and functional problems with speaking, mastication, and deglutition. We report a case of angiokeratoma of the tongue with an underlying hemangioma in a 30-year-old woman. Angiokeratomas have been reported to develop over arteriovenous malformations and in the area of lymphangioma circumscriptum following repeated local trauma. To the best of our knowledge, the development of a lingual hemangioma in a patient with long-standing angiokeratomatous lesions has not been previously reported in the literature.

Primary intraosseous cavernous hemangioma of the zygoma: A case report and literature review

April 30, 2012     Anna M. Marcinow, MD; Matthew J. Provenzano, MD; Richard K. Gurgel, MD; Kristi E. Chang, MD
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Abstract

Intraosseous hemangiomas are rare. We report the case of a 47-year-old man who presented with a gradually enlarging left zygomatic mass that had caused pain, deformity, and superficial soft-tissue swelling. Computed tomography revealed a well-circumscribed 2.0 x 2.5-cm mass with a ground-glass matrix in the left zygoma. Following surgical excision, the patient's symptoms resolved. Findings on pathologic examination of the excised tissue were consistent with an intraosseous cavernous hemangioma. We describe the features of this rare case, we discuss the pertinent radiologic features and pathophysiology of intraosseous hemangiomas, and we review the available literature.

Arteriovenous hemangioma formation following radiofrequency ablation for inferior turbinate reduction

October 26, 2011     Senol Polat, MD, Hasan Murat Tanyeri, MD, and Selcuk Bilgi, MD
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Abstract

Inferior turbinate reduction by radiofrequency ablation (RFA) has been recommended as an easy and safe option for the treatment of patients with inferior turbinate hypertrophy. Complications of this type of excision are generally acceptable. We describe a case of RFA turbinate reduction that resulted in an unusual complication: the formation of an arteriovenous hemangioma.

Approach to benign tumors of the palate: Analysis of 28 cases

August 15, 2011     Ahmet Ural, MD, Murat Livaoğlu, MD, Devrim Bektaş, MD, Osman Bahadır, MD, Atilla Hesapçıoğlu, MD, Mehmet İmamoğlu, MD, and Abdülcemal Ümit Işık, MD
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Abstract

We conducted a retrospective analysis of 28 patients-15 men and 13 women, aged 17 to 71 years (mean: 41.6)-who had undergone surgery for the treatment of a benign tumor of the hard or soft palate. The most common chief complaint was a palatal mass, which was reported by 14 patients (50.0%). Tumors were more common in the hard palate than in the soft palate by a margin of 23 to 5 (82.1 to 17.9%; p = 0.001). The most common histopathologic diagnosis was pleomorphic adenoma, which occurred in 9 cases (32.1%). Most patients were treated with local excision with clear margins, which was sufficient in almost all cases, as there were only 2 recurrences, both of which occurred in men with a hard-palate pleomorphic adenoma. For these 2 patients, a wider excision and repair with palatal islet flaps was performed, and no further recurrence or malignant transformation was observed during follow-up. Two patients with a soft-palate hemangioma were treated with an intralesional steroid injection and radiofrequency ablation, which reduced the size of their lesion considerably.

Hemangioma of a posterior ethmoid sinus: Report of a rare case

December 17, 2010     Anuj Kumar Goel, MS, Samar P.S. Yadav, MS, and Rati Goel, BDS
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Abstract

Very few cases of hemangioma of the ethmoid sinuses have been reported in the literature. These lesions can be difficult to diagnose in the paranasal sinuses because obtaining an adequate biopsy specimen can be dangerous in view of the potential for profuse bleeding. We report a case of a cavernous hemangioma in the right posterior ethmoid sinus of a 45-year-old man. The mass was excised in its entirety.

Submandibular gland hemangioma: Clinicopathologic features and a review of the literature

October 31, 2010     Sudesh Kumar, MS, DNB, Ashok K. Gupta, MS, DLO, MNAMS, and Jayamanti Bakshi, MS, DNB, MNAMS
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Abstract

We conducted a retrospective study to determine the incidence and characteristics of submandibular gland hemangioma at our institution. We reviewed the records of all patients who had undergone submandibular gland excision from January 1998 through December 2006. We found a total of 230 such cases. Of these, submandibular gland hemangioma was found in 4 patients (1.7%)-3 women and 1 man, aged 20 to 47 years (mean 34.8). Their duration of symptoms had ranged from 26 to 78 months (mean: 49.3). These symptoms had included submandibular swelling, pain or discomfort, and features of sialadenitis. Computed tomographic angiography had revealed that the hemangiomas were supplied by the facial and lingual arteries. Two of the 4 patients had undergone preoperative vascular embolization, but it had failed to significantly reduce the amount of intraoperative blood loss. Final histopathologic examination had revealed that all 4 lesions were cavernous hemangiomas and that they had replaced the normal glandular structure. No recurrence was seen during a follow-up that ranged from 47 to 72 months (mean: 56.3).

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