Intramuscular hemangioma of skeletal muscle / 中华骨科杂志

ABSTRACT

Objective Hemangioma had been recognized as one of the most common tumors; however, intramauscular hemangioma (IMH) was a kind of uncommon benign tumor in skeletal muscle. A large number of orthopaedic surgeons knew little about it's specific clinic features. This paper was to report the diagnosis and therapy of 110 IMH cases, and to review tbe causes for misdiagnosis as well. Methods From oct. 1962 to Dec. 1998, 110 patients underwent surgical therapy with the definitive histological diagnosis; the clinical feature, gender, age, value of X-ray imaging, computed tomography(CT), single photon emission computed tomography (SPECT)?magnetic resonance imaging (MRI) and ultrasonography of IMH were analysed. Surgical technique, pathological classification, postoperation effects, prognosis and recurrence reason were discussed. Measures for cmplication and recurrence prevention, differential diagnosis were put forward. Results Anatomical distribution was 11.82% in the neck, 10.91% in the trunk, 16.36% in the upper limb and 60.91% in the lower limb. The disease was characterized by localized pain within soft tissue, local mass, deep tenderness, muscular soreness and mass expansion after exercise. According to Allen's classification, three types were defined: 1) capillary type; 2) cavernous type; 3) mixed type, combination of both, which included miscellaneous types of deep soft tissue(venous,arteriovenous,epithelioid and granulation tissue type). There were capillary type (38.18%), cavernous (33.64%) and mixed type(28.18%). Forty-nine of 110 cases were followed up for an average of six years and two months, the result of 48.98% patients was excellent, 22.45% was good, and 20.41% was unsatisfactory. Only four of 49 cases had local recurrence which was susceptible to infection. Conclusion Intra muscular hemangioma is easy to be mis or under diagnosed, especialy when it is deep or small localized, and it can rarely be diagnosed radiologically unless calcified phlebolithes occurs. Usually, peripheral nerve is not invaded, but could be compressed by the tumor. MRI is most helpful to define the diagnosis, and SPECT can also provide helpful diagnostic information. Although it can be treated by various methods, surgical excision provides the best result. Recurrence can always attribute to incomplete excision. Wide excision of the lesion is the treatment of choice. Preoperative embolization of IMH can reduce intraoperative blood shedding. Embolization combined with surgery forms a new modern approach to treat IMH.