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Nag A, Krema H, Kamil ZS, Al-Mbaideen S. Intramuscular Hemangioma of Lateral Rectus Muscle with Rare Presentation as an Epibulbar Mass: A Case Report and Review of Literature. Case Rep Oncol 2024; 17:712-716. [PMID: 39015646 PMCID: PMC11249565 DOI: 10.1159/000539720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/29/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Intramuscular hemangiomas of extraocular muscles are extremely rare tumors that usually present as retro-orbital masses causing proptosis. We describe a previously unreported presentation, in the form of an epibulbar mass; this easily accessible location allows direct imaging, complete surgical resection, and histopathological confirmation, providing a unique perspective. Case Presentation A 69-year-old woman presented with a painless dark red mass in the lateral part of the right eye, which had been slowly enlarging over the last 18 months. Clinical features and imaging were suggestive of a benign vascular tumor of the conjunctiva. During surgical resection, the mass was observed to be enmeshed within the fibers of the lateral rectus muscle. Careful dissection from muscle fibers was needed for complete excision. Histopathology revealed the diagnosis of an intramuscular hemangioma of extraocular muscle. Conclusion In this report, we describe the atypical anterior epibulbar presentation of intramuscular hemangioma of the lateral rectus muscle. We discuss the differential diagnoses and management of this rare tumor along with a review of existing literature. Careful surgical resection achieved complete resolution in this case without recurrence.
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Affiliation(s)
- Adwaita Nag
- Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hatem Krema
- Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zaid Saeed Kamil
- Department of Diagnostic and Molecular Pathology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, ON, Canada
| | - Suzan Al-Mbaideen
- Department of Diagnostic and Molecular Pathology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, ON, Canada
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Takahashi Y, Vaidya A, Kakizaki H. Improvement of Orbital Intramuscular Hemangioma Following Delivery. Ophthalmic Plast Reconstr Surg 2022; 38:e183-e186. [PMID: 35792735 DOI: 10.1097/iop.0000000000002237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Kirtipur Eye Hospital, Kathmandu, Nepal
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
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Al-Johani S, Al-Romaih A. Intracranial extension of an intramuscular haemangioma of superior rectus: case report and literature review. BMC Ophthalmol 2022; 22:232. [PMID: 35606735 PMCID: PMC9125882 DOI: 10.1186/s12886-022-02429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Intramuscular haemangiomas are rare, benign vascular tumours that represent < 1% of all haemangiomas. When involving the extraocular muscles, haemangiomas are extremely rare, with only nine cases reported in the literature; to date there are no reported cases of extraocular muscle haemangiomas extending into the brain. Case presentation A 6-year-old boy with a two-week history of a painless swelling and erythema on the upper eyelid. On examination, the patient had restricted extraocular motility in all directions of gaze. In addition, the eye appeared proptotic, with chemosis and hyperaemia of the conjunctiva. Visual acuity and intraocular pressure were normal. Orbital computed tomography imaging showed a mass in the left superior rectus, with heterogeneous enhancement following contrast administration. Incisional biopsy revealed an intramuscular haemangioma of the superior rectus muscle with capillary-type vessels. The patient received an intralesional steroid, which improved the condition for a few months; however, the lesion later recurred and included an intracranial extension. Conclusion This case represents the first reported case of intracranial extension of intramuscular haemangioma of extraocular muscle.
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Lai KKH, Li CK, Tsang A, Wong SYS, Ko CKL. Ocular adnexal intramuscular hemangioma arising from the eyelid: case report and literature review. Orbit 2021; 42:290-294. [PMID: 34686104 DOI: 10.1080/01676830.2021.1990352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Intramuscular hemangioma (IMH) is rare in the ocular adnexa and is uncommonly found in infants. We describe a 1-month-old female infant with an unremarkable birth history presented with subacute onset of right upper eyelid swelling. Clinical examination revealed a purplish subcutaneous mass over the right upper eyelid causing mechanical ptosis. MRI revealed a well-defined subcutaneous mass, which was hyperintense on the T1 weighted images and showed intense enhancement after administration of intravenous gadolinium. Our working diagnosis was infantile capillary hemangioma, and the patient received two intralesional steroid injections without diminishing the lesion size. The lesion had become static in size and the subsequent MRI 14 years later revealed the same lesion had become hyperintense on the T1 weighted image. An excisional biopsy revealed mixed type IMH. IMH should be considered among young patients with upper eyelid swelling, particularly in those who show a poor response to steroid treatment.
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Affiliation(s)
- Kenneth K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China
| | - Chun Kit Li
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Alan Tsang
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China
| | - Sivia Y S Wong
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Callie K L Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China
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Bentham R, Jordan DR, Farmer J. A rare case of intramuscular angioma involving the medial rectus muscle. Orbit 2021; 41:647-652. [PMID: 33957847 DOI: 10.1080/01676830.2021.1918179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Benign benign vascular tumors (e.g., hemangiomas) and malformations are commonly encountered lesions in all ages of life, especially in infancy and childhood. Hemangiomas are considered to be proliferative vascular lesions while malformations are defects of embryonal vascular morphogenesis. Less than 1% of hemangiomas within the body occur in skeletal muscle and of these approximately 15% have been reported to occur in the head and neck musculature (e.g. masseter, trapezius, sternocleidomastoid, mylohyoid, temporalis muscles) Intramuscular angioma (the preferred term for lesions formerly known as intramuscular hemangiomas by WHO Tumors of Soft Tissue and Bone Classification, 5th edition 2020) (IA) occurring in the extraocular muscles or palpebral muscles (orbicularis oculi) are extremely rare with only a few case reports in the English literature. To date, all the extraocular muscles have reportedly been involved. With the case reported herein, the medial rectus muscle appears to be the most common extraocular muscle involved.
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Affiliation(s)
- Ricarda Bentham
- Department of Ophthalmology and Pathology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - David R Jordan
- Department of Ophthalmology and Pathology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - James Farmer
- Department of Ophthalmology and Pathology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
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Tabuenca Del Barrio L, Gasparini C, Devoto MH. Intramuscular cavernous venous malformation of extraocular muscles. Fractionated stereotactic radiotherapy as a therapeutic alternative. ACTA ACUST UNITED AC 2020; 95:293-296. [PMID: 32409245 DOI: 10.1016/j.oftal.2020.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 10/24/2022]
Abstract
Intramuscular cavernous venous malformations affecting extraocular muscles are extremely uncommon. Due to their location, complete resection could be difficult. A clinical case is presented of an inferior rectus muscle orbital cavernous malformation treated with fractionated stereotactic radiotherapy after post-surgical excision recurrence. The malformation responded to radiotherapy with a reduction in size and symptoms. Fractionated stereotactic radiotherapy is an alternative and effective treatment for cavernous venous malformations that are surgically challenging due to their radiotherapy sensitivity.
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Affiliation(s)
- L Tabuenca Del Barrio
- Servicio de Oftalmología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - C Gasparini
- Consultores Oftalmológicos, Buenos Aires, Argentina
| | - M H Devoto
- Consultores Oftalmológicos, Buenos Aires, Argentina
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Intramuscular Cavernous Hemangioma of Medial Rectus Muscle in Paediatric Age Group. Case Rep Ophthalmol Med 2017; 2017:1076404. [PMID: 28386496 PMCID: PMC5366764 DOI: 10.1155/2017/1076404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022] Open
Abstract
An 11-year-old male child presented with a mass on the nasal aspect of the right eye that has been there for the last 2 years. Extraocular movements were decreased in the right eye on levoversion, levoelevation, and levodepression. Local examination revealed a bluish mass with irregular surface and ill-defined margins located in the medial rectus muscle. The mass was 10 × 20 mm in size, firm, nodular, nontender, nonpulsatile, noncompressible, and nonreducible. MRI of the orbit revealed a well-defined mass of approximately 23 × 13 mm along the medial rectus (MR) muscle. It was hyperintense on T2W images with very minimal contrast enhancement. A provisional diagnosis of hemangioma or lymphangioma with intralesional haemorrhage was made. During surgical excision, the mass was found to be encapsulated by MR fibres. The MR fibres were separated, and the mass measuring 20 × 8 × 6.5 mm was removed and sent for histopathology. The histopathological examination revealed an intramuscular cavernous hemangioma.
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Lee DE, Park BG, Moon SH, Yang JW. A Case of Surgical Diagnosis and Treatment of Idiopathic Orbital Myositis with Sudden Vision Loss. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.10.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Eun Lee
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byung Gun Park
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Hyuk Moon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Yang
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Silva VA, Lima NL, Mesquita ATM, da Silveira EM, Verli FD, de Miranda JL, Santos CRR, Marinho SA. Intramuscular hemangioma in lip treated with sclerotherapy and surgery. Case Rep Dent 2011; 2011:302451. [PMID: 22567433 PMCID: PMC3335477 DOI: 10.1155/2011/302451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 06/12/2011] [Indexed: 11/20/2022] Open
Abstract
Intramuscular hemangioma is a relatively rare, benign tumor of vascular origin, accounting for less than 1% of all hemangiomas. This paper reports a case of a 48-year-old female patient with intramuscular hemangioma in the upper lip, treated with sclerotherapy and subsequent complementary surgery.
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Affiliation(s)
- Vanessa A. Silva
- School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Nádia L. Lima
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Ana Terezinha M. Mesquita
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Esmeralda Maria da Silveira
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Flaviana D. Verli
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - João Luiz de Miranda
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Cássio Roberto R. Santos
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Sandra A. Marinho
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
- Post Graduate Program in Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), Rua da Glória 187, 39100-000 Diamantina, MG, Brazil
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Abstract
Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.
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Affiliation(s)
- Dong Hwee Kim
- Department of Physical Medicine & Rehabilitation, Korea University College of Medicine, Ansan Hospital, 516 Gojan-dong, Danwon-gu, Seoul, Korea.
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