Intramuscular Hemangioma: A Rare Cause of Omalgia / Hemangioma intramuscular: Uma causa rara de Omalgia

Abstract Intramuscular hemangiomas (IHs) are benign soft-tissue tumors that represent less than 1% of all hemangiomas. This clinical entity is rarely considered as a differential diagnosis in cases of musculoskeletal pain. A healthy 38-year-old woman presented to our office with complaint of left omalgia, with 8 months of evolution, limiting her daily activities. She reported the appearance of tumefaction in the previous 4 months. She was medicated with analgesic and antiinflammatory drugs with no clinical improvement. The objective examination showed limitation of left shoulder abduction (0-90°). The patient underwent a magnetic resonance imaging (MRI), in which a well-circumscribed nodular formation was detected in the deltoid muscle. Then, she underwent a biopsy, which confirmed the diagnosis of hemangioma. The patient was referred for sclerotherapy. Intramuscular hemangiomas are usually observed in young patients. The gold-standard examination for diagnosis is MRI, which often forestalls the need for a biopsy. In many cases, IHs are asymptomatic and tend to involute over time. Despite the low frequency of this clinical entity, it is important to place it as a diagnostic hypothesis in cases of chronic pain of the limbs in young patients with poor therapeutic response to antiinflammatory drugs and analgesia.

Resumo Os hemangiomas intramusculares (HIs) são tumores benignos de tecidos moles que representam menos de 1% de todos os hemangiomas. Esta entidade clínica raramente é considerada como diagnóstico diferencial nos casos de dor musculoesquelética. Uma paciente do sexo feminino, de 38 anos de idade, saudável, se apresentou ao nosso consultório com queixa de omalgia esquerda, com 8 meses de evolução, que limitava suas atividades diárias. Ela relatou o aparecimento de tumefação 4 meses antes da consulta. A paciente estava medicada com analgésico e antiinflamatório sem melhoria clínica. Ao exame objetivo, ela apresentava limitação da abdução do ombro esquerdo (0-90°). A paciente foi submetida a uma ressonância nuclear magnética (RNM) na qual foi detectada uma formação nodular bem circunscrita no músculo deltoide,. Em seguida, foi realizada uma biópsia que confirmou o diagnóstico de hemangioma. A paciente foi então encaminhada para a realização de escleroterapia. Os HIs normalmente são observados em pacientes jovens. O exame padrão-ouro para o diagnóstico é a RNM, que muitas vezes torna a realização de biópsia desnecessária. Em muitos casos, os HIs são assintomáticos e tendem a involuir com o tempo. Apesar da baixa frequência desta entidade clínica, é importante colocá-la como hipótese de diagnóstico em casos de dor crônica dos membros em pacientes jovens com má resposta terapêutica a antiinflamatórios e analgesia.

Hemangioma intramuscular con flebolitos de lengua. Reporte de un caso clínico-patológico

Se presenta un caso de hemangioma intramuscular con flebolitos de lengua en una mujer de 60 años. Clínicamente correspondía a una tumefacción de dos años de evolución, sin signos que sugirieran su origen vascular. Luego de su evaluación inicial se realizó biopsia excéresis de la lesión para su estudio histopatológico. En el estudio histológico se pudo observar una formación tisular redondeada y circunscripta constituida por tejido conjuntivo fibroso con abundantes capilares congestivos que desplazaban el tejido muscular, destacándose la presencia de trombos con calcificaciones dispuestas en capas concéntricas (flebolitos). En base a estos hallazgos morfológicos, el diagnóstico definitivo fue de hemangioma capilar intramuscular con flebolitos de lengua. Para confirmar la naturaleza neoplásica vascular de la lesión se realizó inmunomarcación con el anticuerpo GLUT1. Es de destacar, de acuerdo a la revisión bibliográfica realizada en PubMed, que esta entidad patológica es rara, particularmente en la lengua.

Apresentamos um caso de hemangioma intramuscular com flebólitos de língua em uma mulher de 60 anos. Clinicamente, correspondia a um inchaço com duração de dois anos, sem sinais que sugerissem sua origem vascular. Após sua avaliação inicial, foi realizada biópsia excisional da lesão para estudo histopatológico. No estudo histológico pôde-se observar uma formação tecidual arredondada e circunscrita constituída por tecido conjuntivo fibroso com abundantes capilares congestivos que deslocavam o tecido muscular, destacando a presença de trombos com calcificações dispostos em camadas concêntricas (flebólitos). Com base nesses achados morfológicos, o diagnóstico definitivo foi de hemangioma capilar intramuscular com flebólitos de língua. Para confirmar a natureza neoplásica vascular da lesão, foi realizada imunocoloração com o anticorpo GLUT1. Ressalta-se, de acordo com a revisão bibliográfica realizada no PubMed, que esta entidade patológica é rara, principalmente na língua.

Summary We present a case of intramuscular hemangioma with tongue phleboliths in a 60-year-old woman. Clinically it corresponded to a swelling of two years of evolution, without signs that suggested its vascular origin. After her initial evaluation, an excisional biopsy of the lesion was performed for histopathological study. In the histological study it was possible to observe a rounded and circumscribed tissue formation made up of fibrous connective tissue with abundant congestive capillaries that displaced the muscle tissue, highlighting the presence of thrombi with calcifications arranged in concentric layers (phleboliths). Based on these morphological findings, the definitive diagnosis was intramuscular capillary hemangioma with tongue phleboliths. To confirm the vascular neoplastic nature of the lesion, histochemical immunostaining was performed with the GLUT1 antibody. It is noteworthy, according to the bibliographic review carried out in PubMed, that this pathological entity is rare, particularly in the tongue.

Intramuscular hemangioma of the masseter muscle:a case report

Background - Intramuscular hemangiomas are benign vascular tumours that most frequently occur in the trunk and extremities.They constitute about <1% of all hemangiomas, only 10%–20% have been found to arise in the head and neck region, and 36% of cases involving masseter muscle.They usually present as gradually enlarging soft-tissue mass with or without pain. They are located deep within the muscle, hence rarely exhibit clinical signs or symptoms such as bruits, thrills, pulsation which are suggestive of vascular origin. Due to their rare occurrence, unique location they are often confused with other soft-tissue pathologies such as parotid swelling or other muscular lesions. Case report - 21 year old male came with complaints of swelling and pain over the left cheek for past 6 months which was insidious in onset and non progressive.Patient did not have any history of trauma or increased salivation.On examination swelling of about 2*2 cm over the left cheek,well defined,non tender,soft in consistency.There was no pulsation,bruits or palpable thrill.There was no compressibility and the overlying skin was normal.There was no facial nerve involvement and parotid duct orifice was normal. Conclusion - The possibility of an Intramuscular hemangioma of the masseter muscle should be included in the differential diagnosis of any intra-masseteric lesion. Appropriate radiologic examinations, especially MRI, can enhance accurate preoperative diagnosis; the treatment of choice should be individualized in view of the clinical status of the patient.

Intramuscular hemangiomas on the masseter muscle and orbicularis oris muscle: a report of two cases

Intramuscular hemangioma (IMH) is a rare vascular disease involving skeletal muscle, comprising only 0.8% of hemangiomas. About 10% to 15% of IMHs occur in the head and neck region, mostly involving the masseter muscle. IMH occurs mostly in childhood, but is often not found until unexpected enlargement, pain, or cosmetic asymmetry occurs in adulthood. Several non-surgical treatments including cryotherapy, sclerosant injection, and arterial ligature have been described, but complete surgical resection is the curative intervention. In this report, we present two rare cases of IMH. One IMH case in a 48-year-old male occurred in the masseter muscle feeding from the transverse facial artery. Embolization of the distal branch of the facial artery was first conducted, and then the buccal mass was removed surgically via the intraoral approach. A second IMH case in a 58-year-old female occurred in the orbicularis oris muscle feeding from the superior labial artery, and the mass was excised surgically without embolization.

Intramuscular hemangioma in buccal cheek: a case report

Hemangioma is the most common benign tumor of a vascular origin, and is characterized by the abnormal proliferation of blood vessels. Intramuscular hemangioma (IMH) usually involves the skeletal muscles of the trunk or limbs, but rarely occurs in the head and neck region. This case report presents a patient with IMH showing multiple phleboliths in the buccal cheek. A 13-year-old boy was referred for the evaluation and management of painful swelling of the left cheek that had gradually increased in size over a 6 year duration. The examination revealed a palpable firm mass. Reddish-blue buccal mucosa color was observed with an aciniform shape. Preoperative magnetic resonance imaging (MRI) showed a vascular tumor in the left side adjacent to the buccinator and depressor orbicularis oris muscles. Surgical resection under general anesthesia was performed via the intraoral approach. The mass and phleboliths were extracted successfully. A histopathological examination confirmed the diagnosis of IMH. In conclusion, clinicians should be aware of the possibility of IMH in cases of a palpable mass with multiple nodules deep within the muscle in the buccal cheek. Among the several diagnostic tools, MRI provides essential information on the extent and surrounding anatomy of IMH.

A Case of Intramuscular Muller Muscle Hemangioma of Upper Eyelid Mimicking Sarcoidosis

PURPOSE: We report a case of Muller muscle intramuscular hemangioma in the upper eyelid mimicking dacryoadenitis. CASE SUMMARY: A 21-year-old male patient presented with a 2-year history of upper eyelid swelling in his right eye and no symptom relief with oral corticosteroid. Increased angiotensin-converting enzyme (ACE) was noted in the laboratory findings. However, lid inflammation was not improved and the patient underwent incisional biopsy. CONCLUSIONS: Microscopically, the lesion was composed of proliferating vessels of various sizes between the individual smooth muscle fibers. Intramuscular hemangioma rarely presenting as a benign tumor in the head and neck region can present as diffuse swelling mimicking sarcoidosis or dacryoadenitis.

Intramuscular hemangioma formation in the masseter muscle: a case report

Hemangioma is a benign vascular proliferation. Intramuscular hemangiomas are rare, accounting for less than 1% of all hemangiomas, and occur normally in the trunk and extremities. Approximately 10-20% of intramuscular hemangiomas are found in the head and neck region, most often in the masseter muscles. The typical clinical characteristic is a painful soft tissue mass without cutaneous changes. The suggested treatment is a surgical excision. We report a case of an intramuscular hemagnioma of the masseter muscle. The patient was a 56 year old male who visited our clinic complaining of left facial swelling after 2 years of follow up at a different clinic. After magnetic resonance imaging (MRI), the mass was excised under general anesthesia. The biopsy revealed the mass to be an intramuscular hemangioma. We report the clinical and pathological characteristics as well as the treatment of a case of an intramuscular hemangioma of the masseter muscle.

Lip cavernous hemangioma in a young child

Hemangiomas are benign tumors of infancy and childhood, characterized by a phase of fast growth with endothelial cell proliferation, occurring in 10-12 percent of children at 1 year of age. It is known that hemangiomas of infancy are most commonly located on the head and neck region (around 60 percent of cases) and occur more frequently in the lips, tongue, and palate. Approximately 50 percent of hemangiomas have complete resolution, and 90 percent of them are resolved up to the age of 9. Complications occur in only 20 percent of the cases, the most common problem being ulceration with or without infection. The treatment depends on lesion location, size and evolution stage, and the patient's age. Surgery is usually indicated when there is no response to systemic treatments, or even for esthetic reasons, being performed as a simple excision in combination or not with plastic surgery. This paper reports a case of lip cavernous hemangioma in a 4-year-old child, who was submitted to 3 sessions of vascular sclerosis due to the size of the lesion, before undergoing simple excision of the hemangioma. Two years of postoperative clinical follow-up shows treatment success with no recurrence of the lesion.

Hemangiomas são tumores benignos da infância que se caracterizam por uma fase de crescimento rápido com proliferação de células endoteliais, ocorrendo em 10 a 12 por cento das crianças com 1 ano de idade. Sua localização mais comum é nos lábios, na língua, mucosa jugal e no palato. Aproximadamente 50 por cento dos casos de hemangioma mostram completa resolução e 90 por cento deles resolvem-se até os 9 anos de idade. As complicações ocorrem em apenas 20 por cento dos casos e o problema mais comum é a ulceração com ou sem infecção. O tratamento depende da localização, do tamanho e do estágio evolutivo da lesão, bem como da idade do paciente. A cirurgia geralmente é indicada quando não há resposta aos tratamentos sistêmicos ou por razões estéticas, podendo ser empregada sob forma de exérese simples com ou sem plástica. Este artigo apresenta um caso de hemangioma cavernoso labial em uma criança de 4 anos de idade, a qual, devido ao tamanho da lesão, foi submetida a 3 sessões de esclerose vascular seguido de exérese simples da lesão, com acompanhamento clínico de 2 anos de pós-operatório.

Intramuscular Hemangioma of Temporal Muscle / 대한이비인후과학회지

Intramuscular hemangiomas (IMH) are benign vascular neoplasms arising most frequently in skeletal muscles. They usually present themselves as a soft, non-tender soft tissue swelling. Though hemangiomas are the most common benign neoplasms seen in children, they rarely occur in adults. Pathologically, they are characterized by the proliferation of blood vessels within muscles, occurring most frequently in the large muscle of the extremities and trunks. In the head and neck region, the masseter and trapezius muscles are most commonly involved. IMH within the temporal muscle is reported only a few cases until now. A case of IMH of temporal muscle in a 24-year-old male is reported.

A Case of Intramuscular Hemangioma Presenting with Large-angle Hypertropia

PURPOSE: To report the case of a patient with large-angle hypertropia of an intramuscular hemangioma of the right superior rectus muscle (SR). METHODS: A 63-year-old man with progressive vertical deviation of the right eye for the past 6 months visited our strabismus department; his condition was not painful. An examination indicated that he had 60PD of right hypertropia at distance and near in primary gaze. Additionally, a significant limitation of his downgaze was noted. The right eye appeared mildly proptotic, and the upper and lower eyelids were slightly edematous. Corrected vision was 20/20 in both eyes. RESULTS: Orbital magnetic resonance imaging (MRI) studies revealed fusiform enlargement of the right superior rectus muscle, with prominent but irregular enhancement following gadolinium administration. Incisional biopsy revealed an intramuscular hemangioma in the superior rectus muscle with cavernous-type vessels. CONCLUSIONS: This case demonstrates that intramuscular hemangioma should be considered in the differential diagnosis of isolated extraocular muscle enlargement and unusual strabismus.

Intramuscular Hemangioma of the Mentalis Muscle: A Case Report

Intramuscular hemangiomas are uncommon tumors of the head and neck, consistituting of 0.8% of all hemangioma, but often occur in the trunk and extremities. In the head and neck area, the masseter and trapezius muscle occur frequently, in which diagnosis is often difficult even with accurate preoperative imaging. The definitive diagnosis is made by histological study of the surgical biopsy specimen. Treatment of choice is complete surgical excision. This is, to our knowledge, the first case of intramuscular hemangioma of the mentalis muscle to be reported in korea.

Intramuscular Hemangioma of the Upper Lid

PURPOSE: Intramuscular hemangioma (IMH) is a rare benign tumor occurring frequently on the trunk and extremities. It is uncommon in the head and neck area, especially in the lid, and is difficult to diagnose preoperatively due to its deep location. A case of IMH of the upper lid area is presented. METHODS: A 14-year-old female presented with a mass in the upper lid and brow area of the left side since 1 month of her age. The patient underwent debulking of the mass. The mass was easy to bleed, yellowish and fatty in appearance. The mass infiltrated surrounding orbicularis and frontalis muscle. RESULTS: Microscopically, the mass was composed of vessels of various size and adipose tissues that extended between individual muscle fibers. CONCLUSIONS: IMH is a rare tumor of the periorbital region, hence preoperative diagnosis is difficult. IMH must be kept in mind as the differential diagnosis in patients of young age presenting with a periorbital soft tissue mass.

Case Report: Intramasseteric Vascular Anomaly-Misdiagnosed to Parotid Sialolithiasis / 대한이비인후과학회지

Intramuscular hemangiomas are benign vascular lesions of skeletal muscle and constitutes less than 1% of all hemangiomas. Of all intramuscular hemangiomas, 13-25% occur in the head and neck, presenting lesions of enlarging soft tissue mass associated with pain. Usually they do not exhibit cutaneous changes, such as bluish skin discoloration as seen in cutaneous and superficial subcutaneous lesions. Because of their infrequency, deep location and unfamiliar presentation, intramuscular hemangomas are seldom correctly diagnosed clinically. We encountered a case of intramasseteric hemangioma in a 14-year-old female. She presented intermittent painful swelling on the right preauricular area. Sialography showed a multiple calcified lesion of the soft tissue, while CT scan and MRI showed a tumor mass lying in the masseter muscle. Angiography showed blush lesion but no tumor feeding arteries. After 6 months of intra-lesional sclerosing therapy with alcohol, total regression of tumor was obtained. As we experienced in this case, percutaneous sclerotherapy with alcohol could be the first therapeutic alternative.