Intramuscular Hemangioma Research Articles

Intramuscular hemangioma capillary type with HRAS mutation: Expanding the molecular genetic spectrum with an emphasis on overlap with arteriovenous malformations and distinct from infantile hemangioma

AimsIntramuscular hemangioma capillary type (IHCT) is a rare entity that refers to fast-flow vascular lesions. This study aims to elucidate the relationships between clinicopathological, radiological, and molecular characteristics in IHCT patients. Methods and resultsWe reviewed all IHCT cases which were treated surgically in our pathology database from 2014 to 2023. Ten cases were analyzed via next-generation sequencing (NGS) and Sanger sequencing. The cohort consisted of 10 patients (6 males, 4 females) with a median age of 18 years (range: 1–37). Disease lesions were located in the trunk (n = 4), upper extremity (n = 2), lower extremity (n = 2), shoulder (n = 1), and neck (n = 1). IHCT is most commonly a progressively increasing painless mass. Histopathologically, all lesions exhibited aggregates, lobules, and anastomosing cords of capillary-type vessels separating or infiltrating the skeletal muscles. Four cases exhibited irregularly dilated vessels with thick walls, such as arteriovenous malformations (AVM) in the lesion's periphery. MRI findings commonly demonstrated a well-delineated, homogeneous mass. Somatic mutations were detected in seven of the ten IHCT cases. Four cases harbored mutations in MAP2K1 (p.Q58_E62del, p.K57_G61del, p.K57 N), two cases harbored mutations in KRAS (p.Q61R and p.L56V, p.G13R), and one case harbored a mutation in HRAS (p.D69_Q70insRWYSAMRD). Mutant allele frequencies detected by sequencing ranged from 9.98% to 15.97%. ConclusionsThe hemodynamic and molecular genetic phenotypes of IHCT closely resemble those observed in AVMs. Newly identified KRAS missense mutations, including cases with coexisting mutation types, and HRAS insertion mutations offer valuable insights into the genetic basis of vascular anomalies. These findings may also present potential targets for the development of novel pharmacotherapeutic interventions.

Resected intramuscular hemangioma in the chest wall: a case report

BackgroundIntramuscular hemangioma is an uncommon benign tumor found mainly in the limbs of adolescents and young adults. The local recurrence rate is high, ranging from 30 to 50%, necessitating wide local excision of intercostal intramuscular hemangiomas. However, preoperative diagnosis of intramuscular hemangiomas is challenging. Herein, we report a rare case of an intramuscular hemangioma arising from the chest wall.Case presentationA healthy 29-year-old asymptomatic man was referred to our hospital after an abnormal shadow was observed on his chest radiography. Computed tomography and magnetic resonance imaging revealed a 30-mm-sized mass in the right second intercostal space. Neoplastic lesions, such as schwannomas or solitary fibrous tumors, were included in the preoperative differential diagnosis. Tumor resection was performed using video-assisted thoracoscopic surgery. The tumor, which had a smooth surface covered with parietal pleura, was dissected from the external intercostal muscle and costal bone. Postoperative histopathological examination revealed proliferation of spindle-shaped endothelial cells arranged in a capillary vascular structure accompanied by entrapped smooth muscle fibers, adipose tissue, and muscle vessels. The final diagnosis was an intramuscular hemangioma with negative surgical margins. There was no evidence of recurrence during the 1-year postoperative follow-up period.ConclusionIntramuscular hemangiomas should be considered in the differential diagnosis of chest wall tumors, particularly in young people, owing to their potential for recurrence. Moreover, postoperative follow-up may be necessary for resected intramuscular intercostal hemangiomas.

Pediatric intramuscular hemangioma in the submandibular triangle and other musculoskeletal presentations: A pediatric case series

BackgroundIntramuscular hemangiomas (IMH) account for 0.8 % or less of all benign soft tissue tumors in the general population. Due to their uncommon nature, especially in the head and neck, they are often misdiagnosed and not included in the differential diagnosis. MethodsThis study describes a case series of eleven pediatric patients with a diagnosis of IMH through a retrospective review of the electronic health records and archival records in the Department of Pathology at Children's Hospital of Colorado (CHCO). ResultsThe index case had a unique presentation in the submandibular triangle, while the remaining ten cases are appendicular and thoracolumbar in nature. ConclusionsThis case series contributes to the sparse scientific literature available regarding IMH, particularly in its head and neck presentation as relevant to otolaryngologists.

Intramuscular Hemangioma of the Tongue Misdiagnosed as Cystic Hygroma

Intramuscular Hemangioma of the Tongue Misdiagnosed as Cystic Hygroma

Kavernózní hemangiom temporálního svalu – kazuistika

The authors present a case report of a 37-year-old female patient seen at the ENT clinic for a soft oval swelling on the left temporal region Intramuscular haemangioma is a rare dia gnosis, accounting for only 1% of all haemangiomas. Only 34 cases of intramuscular haemangioma of the temporal muscle have been described in the world literature. In the case report, the authors describe the dia gnostic process, surgical procedure, other therapeutic options, and the follow-up of the patient. Key words intramuscular hemangioma – temporal muscle – preoperative embolization – surgical extirpation

A giant infiltrating angiolipoma of the thigh: a case report

Background: Common vascular lipoma variants, such as angiolipoma, comprise 5–17% of all lipomas. They are categorized into two types: noninfiltrating and rare, deeper infiltrating forms that affect deep soft tissues and skeletal muscle. Young adults with the noninfiltrating type typically have it on their trunk and extremities, most frequently on the forearm. The World Health Organization (WHO) has identified deep infiltrating angiolipomas as intramuscular hemangiomas. The purpose of this case report was to describe a unique instance of a giant thigh angiolipoma that had infiltrated. Case report: A 9-year-old boy patient complained of a lump on the left thigh that was felt about 3 years ago. The lump has grown larger and painful in the last 6 months. He had no history of illness related to her current lump complaint of the thigh. In addition, he also denied any history of trauma. Magnetic Resonance Imaging (M.R.I.) displays hyperintense heterogeny mass with fat and flow void components on T1WI/T2WI/T2STIR. Histopathology signifies mature fat cells that penetrate the surrounding blood vessels, which are accompanied by fibrous connective tissue, indicating an intramuscular-infiltrating angiolipoma. Conclusion: We present a unique instance of a giant infiltrating thigh angiolipoma. Since angiolipoma is an uncommon histological type of giant lipoma, it should be considered in the differential diagnosis.

Modeling and Analysis of Cancer Electrothermic Therapy Technique Based on a Digital Arm

Background: Intramuscular hemangioma (IMH) is a diffuse growth hemangioma located in the striated muscle, which is often overlooked due to its rarity. background: Intramuscular hemangioma (IMH) is a diffuse growth hemangioma located in the striated muscle, which is often overlooked due to its rarity. Objective: This patent pertains to the integration of electroacupuncture with electrothermotherapy. By introducing electrical signals into the electroacupuncture system, electromagnetic heat is produced. This heat leads to the electrolysis and thermal destruction of tumor cells, enabling targeted and precise cancer treatment. Furthermore, the patent offers a theoretical foundation for exploring the distribution of electrical signals and the associated heat in arm muscles, ensuring accurate treatment. Material and Method: To enable subsequent experimental validation, this patent integrates human anatomy and histological structure theory. The arm's geometric structure was derived from segmentation, reconstruction, and substantiation based on a digital human image dataset. Using the COMSOL Multiphysics 5.5 software, a semi-detailed finite element model was developed for the numerical simulation of electrothermotherapy. Within a time domain setting, a carrier signal of 1 MHz and 22 V was introduced to assess the distribution of electrical signals and the associated heat in the arm muscle. Results: Electrical signals, electromagnetic heat, and tissue necrosis primarily concentrate in a spherical region within 10 mm of the exposed electroacupuncture tip, with the maximum coupling temperature reaching 250 °C at the tip. Time domain analysis revealed that the coupling temperature can rise within 1 min, sufficiently to cause complete tissue damage, with the tissue necrosis ratio reaching 100% in the same timeframe. While the coupling temperature continues to rise over time, the increment is modest. After 5 min, there is negligible temperature change, and once the tissue necrosis ratio reaches 100%, it remains consistent. Conclusion: In the precision tumor treatment system utilizing electrothermotherapy, factors, such as the magnitude of the injected electrical signal, placement of the electroacupuncture tip, and treatment duration play a crucial role in the treatment's accuracy. This model delves into the treatment of intramuscular hemangiomas using electroacupuncture electrothermotherapy from two perspectives: spatial and temporal domains. It provides a theoretical foundation for precise electrothermotherapy in cancer treatment. conclusion: In the precise tumor treatment system with electrothermotherapy, the size of the injected electrical signal, the position of the electroacupuncture tip and the treatment duration all have a significant impact on the precise treatment. This model is used to analyzes the treatment of intramuscular hemangiomas with electroacupuncture electrothermotherapy from two aspects: spatial and temporal domains, providing a theoretical basis for the precise electrothermotherapy for cancer. other: null

Expert System for Diagnosing Lipoma Disease in Hospital Patients Latersia Using the Certainty Factor (CF) Method

Lipoma disease is a disease characterized by a lump filled with a layer of fat that gradually accumulates under the skin, where this lump is between the skin and the muscle layer. This disease often appears on the neck, back, shoulders, arms, and thighs. In general, fat lumps or lipomas can be said to have slow growth between the skin and muscle layers. People tend to just let the lumps happen to them and think they are just normal lumps, without carrying out further examinations. The queue to see a doctor for further examination is also a factor. Therefore, it is necessary to make efforts so that the public can obtain information and be able to diagnose lipoma early without having to visit a doctor. From the description above, it is the basis for building a system that can provide information on lipoma disease and diagnose lipoma disease early. The system to be built can produce an early diagnosis analysis based on symptoms that are felt like a doctor, this system is commonly called an expert system, to support accuracy in building an expert system a method is needed in the analysis of its completion. One of the methods to be used is Certainty Factor (CF). The CF method is a clinical parameter value given by MYCIN to indicate the level of trust. The php programming language and MySQL database can build a system for diagnosing lipoma disease using the Certainty Factor method. type of lipoma Lipo Sarcoma 42.24%, Spindle cell lipoma, 56.59%, Myxoid liposarcoma 51.36%, Hibernoma 32%, Intramuscular hemangioma 51.48%, Chondroid lipoma 51.48%, Atypical lipoma 24%. From these results it can be said that the greatest confidence value is the type of Spindle cell lipoma disease with a confidence value of 56.59%.

The diagnosis of retroperitoneal tumors from a radiologist perspective: a case report of a giant intramuscular hemangioma in a 23-year old patient

Primary retroperitoneal tumors are a heterogeneous group of neoplasms with a prevalence of 0.02 to 1%. The results of diagnostic visualization of such tumors are usually ambiguous due to their diversity and similar radiological semiotics of malignant and benign tumor types. The paper describes a rare case of the diagnosis and management of a patient with one of retroperitoneal tumor, i. e. a giant intramuscular hemangioma.
 A 23-year old male patient was referred with complaints of episodic pains in the right inguinal area for 78 years. The multiaxial computed tomography showed a mass of 145 125 125 mm located in the trunk and pelvis, and spreading to the right thigh. The tumor structure was markedly heterogeneous and contained calcinates, adipose tissue, soft tissue and vascular components. The mass showed a heterogeneous contrast accumulation, with predominant delayed-phase enhancement. The tumor was surgically resected, with the histological investigation characteristic of intramuscular hemangioma.
 Rare retroperitoneal tumors are always challenging in the interpretation of the results of diagnostic visualization. Since their various types have similar radiological semiotics, the differential diagnosis is often impossible. Therefore, the main diagnostic issue should be the exact localization of the neoplasm, identification of the feeding vessels, and the assessment of the adjacent tissue abnormalities.

Intramuscular Hemangioma of the Masseter Muscle Mimicking Parotid Sialolithiasis

Intramuscular hemangioma occurs in less than 1% of soft tissue hemangiomas. It is equally prevalent in men and women. In this study, we examined a case of a masseter muscle hemangioma with evidence of a suspected parotid sialolithiasis. A 24-year-old woman with a 3-year history of swelling and mild pain in the cheek and ear area was referred to our Department. Before the sialography, ultrasound imaging (sonography) was performed as an initial examination. Due to the calcification in the anterior region of the masseter muscle observed in earlier CT images, sialography was scheduled for the differential diagnosis of sialolithiasis. Sonograms showed a complex tubular mass of 20 × 35 mm in the anterior region of the masseter muscle. The mass appeared hyper vascular on color Doppler ultrasound, confirming its vascular nature. Due to its proximity to the facial nerve, a diode laser was adopted for treatment. Since intramuscular hemangiomas do not regress spontaneously and can be mistakenly diagnosed as parotid gland tumors or sialolithiasis, correct diagnosis is essential. Sonography can help with this.

Intramuscular Hemangioma of the Sternocleidomastoid: A Rare Tumor in an Unusual Location.

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.

Diagnosis and management of intercostal intramuscular hemangioma: an updated review

BackgroundIntramuscular hemangioma (IMH) is an uncommon type of hemangioma, and primary IMH of the intercostal muscle is even rarer. Only a few reports describe IMH of the intercostal muscle, and there are no review articles on this topic. We report our experience with a younger female patient, who underwent video-assisted thoracic surgery with tumor resection and review the previous literatures of intercostal IMH.Case presentationAn asymptomatic 17-year-old woman showed a 29-mm, homogeneous, intrathoracic nodule in the left chest wall, attached to the second and third ribs on computed tomography. We performed exploratory thoracoscopic surgery and the tumor was excised without surrounding rib resection. Histopathologic examination of the surgical specimen revealed proliferation of small blood vessels within the surrounding striated muscle, leading to the diagnosis of intercostal IMH. The surgical margin was negative. The patient’s postoperative course was uneventful, and there has been no evidence of recurrence for more than 18 months after surgery.ConclusionsWe describe a case of intercostal IMH, who received tumor resection with clear excision margin without surrounding rib resection. Preoperative diagnosis is challenging due to its rarity, but intercostal IMH should be recalled as a differential diagnosis of chest wall tumor. Tumor excision without surrounding rib resection is acceptable for intercostal IMH, when there is a good possibility of achieving negative surgical margin.

Clinicopathological characteristics of 16 cases of intramuscular hemangioma capillary type

目的： 探讨肌内血管瘤毛细血管型（intramuscular hemangioma capillary type，IHCT）临床病理学特征、遗传学特征、诊断及鉴别诊断。 方法： 收集河南省人民医院2012年1月至2022年4月手术切除且明确诊断为IHCT的病例共16例，对其采用免疫组织化学法检测相关蛋白表达，荧光定量聚合酶链反应（PCR）、二代测序检测相关基因突变情况，并文献复习。 结果： 男性7例，女性9例，年龄1~36岁，平均年龄12岁。临床表现为无明显诱因发现局部肿物或受累肌肉疼痛。镜下见病变组织在骨骼肌纤维之间密集生长，边界欠清；低倍镜下可见小的圆形或弯曲的毛细血管形成团块、片状和小叶结构，小血管相互吻合形成管腔；高倍镜下显示内皮细胞肥胖，细胞形态温和，缺乏核的多形性和异型性，伴少量核分裂象，未见病理性核分裂象。8例行PIK3CA、BRAF、KRAS基因检测，均未见突变。4例行二代测序检测，1例存在MAP2K1基因突变（p.Q56P）。 结论： IHCT是一种少见且暂未归类的血管源性良性肿瘤，呈实性肿块样，存在血管内皮细胞增殖和新生血管形成，诊断需与动静脉畸形、婴儿性血管瘤、分叶状毛细血管瘤等鉴别。.

Intramuscular hemangioma presenting as pathological femur fracture: A case report

Hemangioma is a common benign soft-tissue tumor; however, intramuscular hemangioma presenting with a pathological fracture is an infrequent occurrence. Imaging plays a key role in diagnosing this entity. We report a case of a 30-year-old male who presented with a pathological fracture of the left femur following trivial trauma. Clinical examination was remarkable for a significant soft-tissue swelling which on further radiological investigation revealed a soft-tissue mass lesion in the left thigh muscles having multiple vascular channels and phleboliths extending into femoral cortex and medulla causing a pathological fracture. Diagnosing it as an aggressive hemangioma, the main feeder artery was embolized by polyvinyl alcohol particles. The patient is on traction and follow-up. Intramuscular hemangioma causing pathological fracture is extremely rare. Understanding the typical and atypical radiological findings of an intramuscular hemangioma will impede misdiagnosis, and unnecessary tissue sampling, and allow for expedited and appropriate management.

Intramuscular Hemangioma of the Forearm with Phleboliths: A Case Report

Intramuscular hemangiomas of the forearm are rare. Patients typically present with pain, discomfort, and progressive enlargement of the lesion. Diagnosis is often difficult due to their infrequency, deep location, and unfamiliar presentation. In this case report, we present a 47-year-old woman with an intramuscular hemangioma with phleboliths involving the forearm. The patient reported swelling in the right forearm for the past 20 years, which was insidious in onset, gradually progressive in size, and associated with dull aching pain. Upon examination, a soft 20×4 cm swelling was present over the right forearm involving the ulnar aspect, with a positive Tinel’s sign at mid-forearm level. Clinical differential diagnosis included lipomatosis, neurofibroma, and intramuscular hemangioma. On Magnetic Resonance Imaging (MRI), a heterogeneously enhancing serpentine lesion was noted involving the flexor compartment muscles of the right forearm. The patient underwent excision of the lesion, and histopathological examination confirmed intramuscular hemangioma. During the postoperative recovery period, all range of movements at the elbow joint and wrist were normal. No recurrence was noted up to two years of follow-up

Intramuscular Haemangioma of Abductor Hallucis Muscle: A Rare Case Report

Category: Other Introduction/Purpose: Haemangioma is a slow growing benign soft tissue tumor and its presentation in the foot is rare. Intramuscular haemangioma (IH) are usually found before 30 years of age, with gender predominance is still inconclusive. Methods: An 18-year-old woman came with pain and mass in the left foot for the past 3 years. Magnetic Resonance Imaging (MRI) of the left foot shown a heterogenous multilobulated mass, with previously thought originated from flexor digitorum brevis (FDB) muscle. Wide excision was performed. Results: Intraoperative findings showed that the mass actually originated from abductor hallucis muscle. Post-operative histopathological findings confirmed the diagnosis of cavernous-type of intramuscular haemangioma. Conclusion: Literature research identified very few cases of intramuscular haemangioma of the foot. Wide excision of the muscle is a feasible surgical treatment option.

Improvement of Orbital Intramuscular Hemangioma Following Delivery.

A 34-year-old primigravida woman at 26-week gestation presented with gradually progressive right eye proptosis since the early stage of pregnancy. On the first examination, the right eye had 7 mm proptosis, compared with the left eye. Magnetic resonance images demonstrated enlarged inferior and medial recti muscles with tendon involvement. The results of pathological examination of a specimen harvested from the medial rectus muscle lesion 1 month after the delivery corresponded to an intramuscular cavernous hemangioma. Three months after biopsy, the right eye had a 3-mm reduction in proptosis, and magnetic resonance images showed slight reduction in size of the medial rectus muscle lesion. The maximum diameter of the right medial rectus muscle measured on axial images decreased from 13.13 to 9.38 mm. The patient underwent balanced orbital decompression 8 months after the biopsy. At 9-month post-decompression period, the right eye had 3.5-mm proptosis, and the vision was stable.

The Challenges of Upper Extremity Intramuscular Hemangioma: A Case Study and Systematic Review

Intramuscular hemangiomas are rare, benign vascular tumors, constituting 0.8 percent of all hemangiomas. Upper extremity intramuscular hemangiomas pose diagnostic and therapeutic challenges because of their rarity, invasive nature, and potential for neurovascular involvement. The authors report a comprehensive systematic review of upper extremity intramuscular hemangioma management and a challenging case report. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were used to identify articles describing upper extremity intramuscular hemangiomas 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). Eighteen articles encompassing 25 patients were included in the authors' systematic review. Of those, 18 underwent primary excision and seven 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 percent of secondary cases. Primary excisions demonstrated smaller size of mass (19.4 cm 2 versus 165.3 cm 2 ) and superior reported functional outcomes (100 percent versus 33 percent). Complications were reported in 5 percent of the primary excisions compared to 71 percent of the secondary excisions, where one complication was a fatal hematoma. The literature concerning upper extremity intramuscular hemangioma 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 upper extremity intramuscular hemangiomas. At early stages, smaller lesion size significantly reduces the risk of functional impairment and complications.

Intramuscular haemangioma in a child

Aim of the study: To outline the challenge faced in diagnosing intramuscular haemangioma of the masseter in a child. Intramuscular haemangioma is an unusual type of haemangioma and is oftentimes overlooked or misdiagnosed by health care professionals. Case report: Herein, we discuss a complex case of a 9-year-old girl referred to otorhinolaryngology department for unilateral preauricular swelling, initially treated as parotitis and finally diagnosed as intramuscular masseter haemangioma following imaging and biopsy. However, the patient had to complete several courses of antibiotics and fine needle aspiration, which was inconclusive, for almost a year prior to attaining diagnosis. Conclusion: We would like to highlight early imaging and image-guided biopsy especially in children to avoid delay in diagnosis and prompt management.

Intramuscular Neck hemangioma - A Case Report

Intramuscular hemangiomas are rare neoplasms of blood vessel origin located inside muscles, which may not be clinically apparent at presentation. We present one such interesting case which was deceiving enough to remain unnoticed on initial short clinical examination and produced a misleading cytological diagnosis up front. High resolution ultrasound gave a clue to the diagnosis of the tumor. More specific radio-labelled RBC scan confirmed its presence, while fusion imaging pin-pointed its location. Bangladesh J. Nuclear Med. 24(1&2): 68-72, 2021