Intraosseous Hemangioma Research Articles

Pediatric Scapular Cavernous Hemangioma Presenting with Kasabach–Merritt Syndrome and Controlled by Preoperative Angioembolization: A Case Report

AbstractIntraosseous hemangioma is a common and benign vascular tumor with a propensity to occur in any bone of the body. Although the most common skeletal sites are the craniofacial bones and the spine, hemangioma of the scapula is a rare occurrence, which is rarer in the pediatric population. Kasabach–Merritt syndrome (KMS) is characterized by the combination of a rapidly growing vascular tumor, thrombocytopenia, microangiopathic hemolytic anemia, and consumptive coagulopathy. This condition can cause massive bleeding even after minor trauma and immediate operative management is usually contraindicated.We report a rare case of KMS in an 8-year-old girl with cavernous hemangioma of the scapula presenting with progressively increasing shoulder mass, thrombocytopenia, and serially falling hemoglobin levels. She was treated with preoperative angioembolization to manage the consumptive coagulopathy followed by surgery poststabilization. Intraosseous hemangiomas, while benign, can show aggressive features on imaging and angioembolization can be a life-saving tool in the management of vascular tumors presenting with consumptive coagulopathy. Intraosseous hemangiomas, while benign, can show aggressive features on imaging and angioembolization can be a life-saving tool in the management of vascular tumors presenting with consumptive coagulopathy.

Primary Intraosseous Hemangiomas of the Maxillary Bone: A Case Report and Literature Review.

Primary intraosseous hemangiomas of the maxillofacial region are rare lesions that comprise less than 1% of all osseous tumors. A review of the literature on primary intraosseous hemangiomas of the facial bones revealed a limited number of publications, much of which was largely limited to case reports. This case report summarizes the workup and surgical treatment of a 37-year-old female with a primary intraosseous hemangiomas of the left maxillary bone. The image, histology, treatment, and literature are reviewed.

Preoperative planning of craniectomy and reconstruction using three-dimension-printed cranioplasty for treatment of calvarial lesion.

Common calvarial lesions include fibrous dysplasia (FD), intraosseous meningioma, osteoma, Langerhans cell histiocytosis (LCH), intraosseous hemangioma, dermoid and epidermoid cyst, and malignancy. Surgical removal with removal of the involved skull is the choice of treatment for these lesions. Previously, the skull defect was repaired using allograft, and alloplastic materials have been replaced with newer polyetheretherketone (PEEK) material, which is more resistant, biocompatible, and can be 3-dimension (3D)--printed. High-resolution 3D printing uses very fine extruders to put materials in fine layers to recreate patients' anatomy authentically, which gives superior cosmetic outcomes. Our objectives were preoperative planning of craniectomy and reconstruction for calvarial lesions and reconstruction of skull defects using 3D-printed cranioplasty with PEEK materials. In this series, we describe 11 cases in which skull lesions were removed and reconstructed in the same sitting using a 3D-printed PEEK implant designed preoperatively using high-resolution computer tomography. All the cases were done in the neurosurgery department of Bangabandhu Sheikh Mujib Medical University from 2021 to 2023. Patients were followed up for 6 months after surgery. Regarding 11 cases, six cases were FD, three cases were intraosseous meningioma, one case was intraosseous hemangioma, and one case was LCH. Average lesion size were 12.73-5.77 cm. Cranioplasty was done with PEEK material. Minor complications were treated conservatively. Seroma, postoperative fever, and nausea were among these. The human bone-like biocompatibility and resistance to physical forces leads to more frequent use of PEEK, which enables to repair of complex craniofacial defects with better cosmesis. Despite some limitations, the PEEK cranioplasty implant continued to thrive and showed its promise to be an excellent material. Further, research and investment should be put into developing the technique.

INTRAOSSEOUS CAVERNOUS HEMANGIOMA OF THE ZYGOMA: A CASE REPORT

The incidence of intraosseous hemangiomas is low; they represent less than 1% of all bone tumors. The most common locations are the calvaria and vertebrae. Lesions affecting facial bones are rare and can involve the maxillae, mandibulae, nasals, and zygomatics. In zygomatic location its a slow-growing tumor that primarily affects adult women. Herein, we report a case of intraosseous hemangioma of the zygomatic bone in a man aged of 55 years old. The diagnosis of intraosseous hemangioma was made following radiological examination due to the characteristic imaging findings and confirmed after surgical excision by anatomopathological exam.

A Rare Case of Clival Hemangioma Simulating Chordoma

AbstractPrimary intraosseous hemangiomas are rare, benign, vascular malformations that account for ∼1% of all primary bone neoplasias. A 59-year-old female patient with unknown comorbidities had a history of headache, visual impairment and dizziness that led to the diagnosis of a clivus tumor. Two resections were attempted through transcranial and transnasal transsphenoidal approach in the last two years in another hospital. The initial MRI scan showed an expansive lesion with T2 hyperintense signal and diffuse, heterogenic contrast enhancement. Clival chordoma was the main diagnostic hypothesis done. A CT scan was performed to evaluate the extent of clival invasion, the sinus anatomy, and the clival destruction - all simulating clival chordoma. The interdisciplinary tumor board decided to proceed with endoscopic endonasal tumor resection. There were no postoperative complications and the histopathological analysis revealed a primary intraosseous haemangioma. Skull base intraosseous hemangiomas are rare entities, with a limited number of case reports found after literature reviews, especially in the clival region. The clinical pattern and imaging characteristics can vary widely according to the tumor extension and development, simulating some other common tumors found at this topography. We present a case report of a clival intraosseous hemangioma presenting as an isolated abducens paresis with a positive outcome after intranasal endoscopic resection after two years of follow-up.

Intraosseous cavernous hemangioma of parietal bone: A case report and literature review

Introduction and background: Intraosseous Hemangiomas or Primary Intraosseous Hemangiomas (PIH) are slowgrowing innocuous blood vessel tumors that make up less than 1% of all bone malignancies [1-4]. These lesions are estimated to account for 0.2 percent of all benign skull tumors [4-8], with a clear female predisposition (3:1) [2]. Prior trauma to the region is thought to be the most prevalent cause of intraosseous hemangiomas. They bleed profusely when removed or biopsied; therefore, preoperative diagnosis of the lesion’s vascular character is critical [8]. They are most frequently seen in the vertebral skeleton, although they can also be found in the calvarium and facial bones. The temporal bone is the most prevalent place in the head after the vertebral skeleton, followed by the parietal, mandible, malar, and zygomatic areas [8]. In this case report, we discuss the case of a 9-year-old male who presented with a large soft mass in his right parietal region.

Intraosseous cavernous hemangioma of parietal bone: A case report and literature review

Introduction and background: Intraosseous Hemangiomas or Primary Intraosseous Hemangiomas (PIH) are slow-growing innocuous blood vessel tumors that make up less than 1% of all bone malignancies [1]. These lesions are estimated to account for 0.2 percent of all benign skull tumors [4], with a clear female predisposition (3:1) [2]. Prior trauma to the region is thought to be the most prevalent cause of intraosseous hemangiomas. They bleed profusely when removed or biopsied; therefore, preoperative diagnosis of the lesion’s vascular character is critical [8]. They are most frequently seen in the vertebral skeleton, although they can also be found in the calvarium and facial bones. The temporal bone is the most prevalent place in the head after the vertebral skeleton, followed by the parietal, mandible, malar, and zygomatic areas [8]. In this case report, we discuss the case of a 9-year-old male who presented with a large soft mass in his right parietal region.

Locally Aggressive Rib Hemangioma With Glomeruloid and Papillary Features - Expanding the Clinicopathologic spectrum of Bone Hemangiomas.

Intra-osseous hemangiomas are uncommon tumors that can present diagnostic and treatment dilemmas. Bone hemangiomas with papillary and glomeruloid growth patterns are exceptionally rare. We present an example of an intra-osseous hemangioma of the rib displaying aggressive features on both radiology and histology. Morphologically, prominent papillary and glomeruloid architectural patterns were observed, in addition to features of cavernous and capillary hemangiomas. Extensive extra-osseous soft tissue involvement was seen. Awareness of the diverse histological features and locally aggressive behavior of bone hemangiomas is important in avoiding over-interpretation as a malignant lesion.

Intraosseous hemangiomas in children. Diagnosis and treatment particulars. Case presentation

Hemangiomas of the jaw bones in children are extremely rare, but can have severe adverse effects.The goal. The purpose of this paper was to draw attention to the diagnostic problems of hemangiomas in children with coagulopathy problems, especially bone ones. Materials and methods. A special case of hemangioma of the mandible, in an adolescent with coagulation pathology, is presented. Results. The literature review and the present case found many identical problems, but also diagnostic and treatment peculiarities. Conclusion. Mandibular bone hemangiomas are rare vascular formations. The diagnosis of hemangiomas in children is difficult because of the rare incidence, treatment peculiarities, as well as because of hidden clinical signs. The general examination is necessary for all forms of hemangiomas and especially for those localized in the jaw bones. Coagulopathy problems greatly complicate the choice of treatment methods. Drug treatment is the favorable option of all treatment options at the present time. Choosing the right treatment method is an important moment in the prevention of side effects.

Intraosseous Hemangioma of Zygoma: A Case Report with Review of Literature

Intraosseous Hemangioma of Zygoma: A Case Report with Review of Literature

Differential pericyte marker expression in craniofacial benign and malignant vascular tumors.

Vascular anomalies and tumors are common in the head, neck, and craniofacial areas and are associated with abnormalities in the angiomatous architecture. However, the etiology and molecular basis for the pathogenesis of most vascular lesions are still unknown. Pericytes are mural cells that surround endothelial cells. Besides angiogenesis and other physiological functions, pericytes play an important role in vascularized tissue repair and as resident mesenchymal stem/progenitor cells. Perivascular cells demonstrate a distinct immunohistochemical profile, including expression of alpha-smooth muscle actin (α-SMA), CD146, CD105, and PDGFRβ, without endothelial differentiation (absence of CD31 and CD34 immunoreactivity). These pericyte markers have been shown to be expressed in soft tissue hemangiomas. However, they have not been fully examined in intraosseous hemangiomas. In this study, we compared mesenchymal stem cell (MSC)expression of CD146 and α-SMA markers inpericytes from hemangiomas from different tissues and malignant vascular tumors. The results demonstrated an increased expression of pericyte markers in perivascular cells of benign hemangiomas, especially intraosseous hemangiomas and a significantly reduced expression of pericyte markers in malignant angiosarcomas. The evidence provides insight into the function of pericytes in vascular tumors and suggests their role in vascular tumor disease types.

Supraorbital Rim and Roof Reconstruction with Vascularized Fascia Lata and Autogenous Rib Graft.

Describe a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof. Retrospective chart review and description of surgical technique. Four patients underwent tumor resection with neurosurgery (2 intraosseous hemangioma, 1 meningioma, and 1 ossifying fibroma), with mean tumor size of 42.6 cubic centimeters on preoperative imaging. All defects involved supraorbital rim and orbital roof. Patients were reconstructed with autogenous osseous rib graft for structure and contour and anterolateral thigh fascia lata (ALTFL) free flap to provide robust vascularity to rib bone and as a barrier between skull base dura and the orbit and/or sinonasal cavities. Two patients underwent resection and reconstruction using minimal access incisions, and two underwent major cranial and skull base resections. All flaps are vascularized via superficial temporal vessels. On postoperative follow-up (mean 33.5 months, range 8-48), all patients report no vision change or diplopia, with excellent contour symmetry to contralateral orbit. Follow-up imaging (mean 29.5 months, range 3-48) demonstrated maintained orbital volume and retention of rib bone graft compared to immediate postoperative imaging. There were no complications related to graft use. Minor complications include 1 patient with cerebrospinal fluid leak managed with lumbar drain placement and 1 patient with mild enophthalmos at 7-month follow-up. We describe a series of patients who underwent a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof with autogenous osseous rib and vascularized ALTFL-free flap with excellent functional and cosmetic outcomes. This can be accomplished using minimal access techniques to minimize patient morbidity. 4 Laryngoscope, 134:654-658, 2024.

Imaging features of intraosseous hemangiomas: beyond the mobile spine and calvarium.

Describe imaging features of intraosseous hemangiomas located outside of the mobile spine and calvarium. Imaging and medical records were retrospectively reviewed for cases of intraosseous hemangiomas located outside of the calvarium and mobile spine. Evaluation included patient demographics, histologic confirmation, and imaging characteristics. Thirty-six patients were included (25 F, 11M; mean age 54 ± 17years, range 10-84years) with 37 total lesions (70% axial and 30% appendicular skeleton). Mixed lytic and sclerotic features were identified on 83-85% radiographs and CTs. Amorphous increased density mimicking osteoid matrix was present on 38-45% radiographs and CTs. Classic honeycomb or radial pattern was identified on 45% of CTs. Osseous expansion and cortical permeation were common features. CT identified periosteal reaction in 24% of lesions. All hemangiomas had heterogeneous MRI signal and most moderately or avidly enhanced. Intralesional fat was identified on 78% MRIs, often as a minor component and only detected on 24% of CTs. A soft tissue mass was present on 52% of MRIs. FDG PET/CT mean SUVmax of 3.2 ± 0.6 (range 1.9-5.0). Lesional FDG activity relative to background marrow was increased in 75% of lesions. Lesions with cortical permeation had higher metabolic activity versus those without (3.5 ± 0.7 versus 2.2 ± 0.3, p = 0.041). Intraosseous hemangiomas outside of the mobile spine and calvarium demonstrate more aggressive imaging features compared to vertebral hemangiomas, including cortical permeation, soft tissue mass, amorphous increased density mimicking osteoid matrix, and increased FDG activity.

Endoscopic Excision of the Intraosseous Hemangioma of the Nasal Bone.

The online version contains supplementary material available at 10.1007/s12070-023-03729-x.

Forty-five-months follow-up of a minimally invasive, interdisciplinary treated hemangioma of the mandible with a high risk of severe bleeding – a case report

BackgroundHemangiomas are benign tumours, mostly seen in the soft tissues. The intraosseous appearance is rare, in particular in the jaws they represent a very seldom malformation.AimTo present a combined endodontic and surgical management report of a clinical case with a rare intraosseous hemangioma diagnosis in the mandible.Case presentationThis well-documented case report describes the interdisciplinary treatment approach of an intraosseous hemangioma in the left mandible of a 70-year-old male patient. This incidental finding was detected through a routine dental examination. The panoramic radiograph revealed an asymptomatic, apical translucency approximately 15 mm diameter with contact to the mesial root of the tooth 36. The clinical examinations showed no abnormalities. The multifaceted specialized treatments started with the endodontic treatment of the tooth prior to the surgical removal of the lesion and were followed by the histological assessment. As derived from the histologically verified diagnosis, this rare case included the risk of severe bleeding complications during therapy.

Cavernous Hemangioma of Maxilla

Intra-osseous vascular lesions occur rarely in jaw bones. Intra-osseous hemangioma of the facial bones is even rarer and occurs more predominantly in the mandible than the maxilla. Diagnosis of these lesions is challenging due to inconsistent clinical and radiographic presentation. Here, we present a rare case report of a boy, aged 16 years, with an intra-osseous cavernous hemangioma of the left maxilla.

INTRAOSSEOUS HEMANGIOMA IN MAXILLA: A RARE ENTITY

A 49-year-old woman sought dental care, complaining of facial pain. On physical examination, a tumefaction of hardened consistency was noted in the paranasal region, measuring approximately 2 cm in diameter. Computed tomography revealed the presence of a heterogeneous mass with soft tissue density, containing images of bone inside. The lesion was located lateral to the piriform opening, occupying part of the right maxillary sinus. The diagnostic hypothesis was a benign fibro-osseous lesion. An incisional biopsy was performed. Histopathologic examination showed the presence of large vascular spaces lined by a thin endothelium and separated by a fibrous connective tissue and vital bone trabeculate. The final diagnosis was maxillary intraosseous hemangioma. The lesion was then completely surgically removed, and the patient remains under clinical follow-up. No recurrence was observed after 2 years. Intraosseous hemangiomas represent less than 1% of intraosseous tumors and are more frequent in the mandible.

Hemangioma of temporal bone: clinical case

Vascular tumors often localized in the region of head and neck. Intraosseous hemangiomas localized mainly in the vertebrae and in the skull bones, but they are rarely found in the temporal bone. More often, intratemporal hemangiomas are localized in the internal auditory canal or in the area of the geniculate ganglion and Scarpas ganglion, due to the abundant blood supply of these areas. In other areas of the temporal bone, hemangioma is extremely rare. The symptoms depend on the localization and size of the tumor. The main clinical manifestations of the disease: facial nerve palsy, hemifacial spasm, cochleovestibular symptoms. The data of computed tomography (CT) and magnetic resonance imaging (MRI) are non-specific. Angiography is recommended to identify the anatomical features of the vessels like aberrant internal carotid artery, high jugular bulb), the blood supply of the tumor and the possibility of embolization, which significantly reduces the risk of bleeding and damage to important anatomical structures of the temporal bone during surgery. Differential diagnosis is carried out with many diseases of the temporal bone: cholesteatoma, glomus tumor, shwannoma of the VII and VIII cranial nerves, Langerhans cell histiocytosis, rhabdomyosarcoma, etc. Surgical treatment is the method of choice and allows to completely resect the tumor. The article presents a clinical case of intratemporal hemangioma in a patient with a long term symptom of hearing loss.

Intraosseous Hemangioma of the Ethmoid Sinus: A Case Report.

Intraosseous hemangiomas usually occur in the vertebrae and skull bones, whereas those arising within the nasal cavity are exceedingly rare. Here, we describe the case of a 40-year-old woman with nasal congestion who presented to our hospital with a tumor located in the left nasal cavity. Unenhanced paranasal computed tomography revealed an approximately 3cm large mass originating from the anterior wall of the ethmoid sinus. Pre-operative imaging failed to reveal the etiology of the mass. The tumor was successfully resected using a trans-nasal endoscopic approach without pre-operative embolization. No complications occurred during the post-operative period, and there was no evidence of recurrence at the 3-month and 6-month follow-up. Histological examination of the resected specimen showed endothelium-lined blood-filled vascular spaces within the bony trabecule, suggesting a pattern typical of intraosseous cavernous hemangioma. Thus, although intraosseous hemangiomas of the nasal cavity are extremely rare, they must be considered when a bony mass is detected in the nasal cavity.

Surgical Management of a Massive Frontal Bone Hemangioma: Case Report.

Intraosseous hemangiomas are rare, benign tumors that can arise from the calvarium. These lesions often invade the outer table of the skull, but typically spare the inner table and intracranial structures. En bloc surgical resection is the standard treatment for intraosseous hemangiomas. However, a piecemeal resection may be required to safely remove the tumor in cases involving the inner table to protect the underlying brain parenchyma and vascular structures. Proper reconstruction is critical to optimize the cosmetic outcome, and a staged procedure allowing implantation of a custom-made implant can be considered for large lesions involving the forehead. We present a case of a patient with a large frontal intraosseous hemangioma with intradural involvement to highlight the surgical nuances of resection and review the existing literature regarding optimal management of these patients.