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Intraosseous hemangiomas rarely occur in jaw bones. Clinically, mucosal and soft tissue lesions are easily diagnosed, but intrabony lesions are difficult to distinguish due to varying symptoms, ranging from tooth mobility to pulsatile bleeding. These lesions also exhibit marked variability in their radiological appearance. We present a rare case report of a 75-year-old male with cavernous hemangioma of the left mandible with vague clinical features but characteristic radiographic and histological features.

Papillary hemangioma is a novel variant of intravascular hemangioma. It is more common in adults and has a male predominance. Most tumors reported so far are solitary and cutaneous. Here we present a rare case of an intraosseous papillary hemangioma involving the frontal bone. Brain imaging in a 69-year-old man with a slowly enlarging swelling on the right frontal area following an accidental fall demonstrated a 4.5 cm × 1.7 cm × 4.2 cm mass originating from the right frontal bone, with a tiny defect on the orbital roof. A malignant process was favored, and the mass was removed. Histopathology revealed a vascular lesion showing intraosseous distribution with foci of extension into the fibrous connective tissue. There were areas of plump endothelial cells with intracytoplasmic hyaline globules arranged in papillary configuration. The lesional cells were immunoreactive with CD34. AE1/AE3, EMA, PR, D2-40, inhibin, and S100 stains were negative. Ki-67 was low. This is the first intraosseous and second noncutaneous papillary hemangioma. Clinically it differs from other cases by the presence of trauma as a preceding event. Since its prognosis is unknown such patients should be monitored for recurrence or malignant transformation. [ABSTRACT FROM AUTHOR]

A 28-year-old female presented with a slowly enlarging, left cheek mass over two years. She underwent neuroimaging and was found to have a well-defined, low attenuating lesion with thickened vertical trabeculation of the left zygoma, consistent with intraosseous hemangioma. To minimize the risk of severe intraoperative hemorrhage, the patient underwent embolization of the mass by neuro-interventional radiology two days prior to resection. The patient subsequently underwent a left anterior orbitotomy and partial zygoma resection followed by reconstruction of the lateral orbit with a custom porous polyethylene zygomaxillary implant. The postoperative course was uneventful with a good cosmetic outcome. [ABSTRACT FROM AUTHOR]

Intraosseous hemangioma is a benign, rare neoplasm that accounts to 0.5 - 1% of all benign tumors of bones.1, 2 While most hemangiomas arise from soft tissues, it is uncommon for it to arise from bones.2 The most common sites of growth are in the vertebral body and the calvarium with frontal bone making up approximately 45% of calvarial cases.2,3 However, they are also encountered in the head and neck with sites such as the skull (53%), mandible (10.7%), nasal bones (9%), and cervical spine (6%).4 In the mandible, the body is mostly affected and 65% are found in the molar and premolar region.1 They are more common in adult females with peaks at the second and fifth decades of life.1-3 Hemangioma of the mandible is difficult to diagnose due to its nonspecific clinical presentation and radiographic features. It mimics various mass lesions in the mandible such as giant cell granuloma, fibrous dysplasia, multiple myeloma, osteosarcoma, ameloblastoma and keratocysts. Therefore, a comprehensive history taking and physical examination plus examination of the imaging studies available and tissue biopsy all play important roles in arriving at the final diagnosis.5 We present the case of an aggressive mandibular hemangioma in a young boy and our management involving a failed fibular free flap reconstruction.

Two patients with papillary thyroid carcinoma and an elevated thyroglobulin had false-positive imaging studies from intraosseous hemangiomas (IH). A 62-year-old man presented with a palpable lytic skull mass suspicious for a bone metastasis after computed tomography (CT) and magnetic resonance imaging (MRI) scans. Surgical excision confirmed an IH. The second patient is a 64-year-old woman whose I-123 whole-body scan with single photon emission computed tomography/CT demonstrated radioiodine uptake in the right frontal bone. Her MRI and CT scans were also consistent with an IH. These cases reveal the limitations of nuclear imaging and of CT and MRI scans in distinguishing metastatic differentiated thyroid cancer from IH in patients with lytic bone lesions. Because no imaging studies are definitive for an IH, bone cranial lesions may warrant resection to establish a diagnosis and avoid potential brain invasion by a malignancy or unnecessary radioiodine treatment. [ABSTRACT FROM AUTHOR]

Objective: Describe imaging features of intraosseous hemangiomas located outside of the mobile spine and calvarium. Materials and Methods: 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. Results: Thirty-six patients were included (25 F, 11 M; mean age 54 ± 17 years, range 10–84 years) 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Intraosseous hemangiomas are uncommon slow-growing benign bone tumors. Most of these lesions are located in the spine or skull and long bone location is rare. Here we present the case of a 63-year-old female with a pathological fracture of the left proximal humerus through an intraosseous hemangioma. Imaging features can be highly unspecific when these tumors are found in the long bones. In this case a pathological fracture obscured the diagnosis even further, prompting the need for tissue sampling to exclude an underlying malignancy.

Background: Intraosseous hemangiomas occurring the clavicle is uncommon. Reconstruction of the clavicle is suggested to maintain the normal shoulder joint function and prevent adverse outcomes. Complex anatomy shape of the clavicle remains a great challenge for prosthetic reconstruction of the clavicle.Case presentation: A 37-year-old female with no conclusive history of trauma presented with progressive mass at the right lateral clavicle for 5 years. The patient was treated by surgical resection and reconstructed by three-dimensional-printed personalized prosthesis. Postoperatively radiographic examinations revealed a good position of the prosthesis, neither breakage nor loosening was detected. The right shoulder mobility returned to approximate level of preoperative shoulder 2 months after surgical reconstruction, with the range of motion of flexion 80°, extension 40°, abduction 80°, adduction 30°, external rotation 55°, and internal rotation 60°. The patient maintained the normal shoulder function during the 48 months follow-up period. There was no pain during shoulder motion. The Musculoskeletal Tumor Society Score (MSTS) score was 29 and the Functional Evaluation Form recommended by the American Shoulder and Elbow Surgeons (ASES) score was 95.Conclusion: 3D-printed personalized prosthesis is a good option to reconstruct the lateral clavicle bone defect and restore the shoulder support structure. It maintains the normal shoulder joint function and avoids adverse effects on daily activities after claviculectomy.

An intraosseous hemangioma is a rare benign tumor of the bone. Moreover, it is rarely observed in the nasal bone. A 58-year-old female patient complained of swelling in the nasal dorsum and mild pain. CT showed a round mass with a honeycomb appearance meanwhile, MRI revealed a hypointense mass in T1 sequences and hyperintense in T2 and gadolinium sequences. Endoscopic removal of the intraosseous hemangioma was performed. No recurrence was observed in the post-op 6th-month follow-up. [ABSTRACT FROM AUTHOR]

BackgroundPrimary intraosseous cavernous hemangioma is a benign tumor with slow growth and is rarely seen in clinics. The clinical manifestations of most patients are progressive enlargement of the head mass.Case presentationWe report a 30-year-old female patient with cavernous hemangioma at the frontoparietal junction. Upon admission, the right frontal lobe mass was progressively enlarged for 3 years and underwent lesion resection and stage I skull reconstruction. The postoperative outcome was good, with no recurrence at 1-year follow-up.ConclusionPrimary intraosseous cavernous hemangioma is a relatively rare clinical tumor, the pathogenesis of which is still unclear, and most of them have no specific clinical manifestations. Characteristic imaging findings are highly suspicious of this disease, but the definitive diagnosis still depends on histopathological examination. Currently, total surgical resection of the tumor is a relatively effective and preferred treatment.

Background. Intraosseous hemangiomas are rare benign tumors comprising fewer than 1% of all osseous tumors; even more uncommon are intraosseous hemangiomas of the zygomatic bone. This case reports a multidisciplinary approach for excision and reconstruction of an intraosseous hemangioma of the zygomatic bone in a 54-year-old female. Methods. Multidisciplinary approach with both otolaryngology head and neck surgery and oculofacial plastics and reconstructive surgery included right lateral canthotomy and right transconjunctival orbitotomy with en-bloc excision of the zygomatic arch, followed by reconstruction of the orbital rim, orbital floor, and eyelid with Medpor implant. Results. Final surgical pathology was consistent with intraosseous hemangioma of the zygomatic bone. At 4-month follow-up, the patient was healing well with good midface projection and without any visual deficits. Conclusions. A multidisciplinary coordinated case allowed us to meet the standard of maintaining cosmesis and function while undergoing resection of a rare tumor involving a key facial structure--the zygoma. Involvement of oculofacial plastics and reconstructive surgery service allowed for advanced eyelid reconstruction techniques to limit any functional impairment to our patient with deliberate choice of implant material for well-adhered, durable, and aesthetically optimal reconstruction of the right malar eminence, lateral orbital rim, and orbital floor defect. The postoperative result through the multidisciplinary approach was a near symmetrical facial reconstruction without any associated eyelid or globe abnormalities. [ABSTRACT FROM AUTHOR]

Intraosseous vascular lesions are rare conditions, comprising only 0.5% to 1% of all intraosseous tumors. They present with variable and atypical radiographic appearances. Because of this variation, no pathognomonic sign exists that can be used to make a definite clinical diagnosis of these tumors. But, early diagnosis of central hemangioma is essential for preventing uncontrollable hemorrhage and even death during biopsy or surgery. The purpose of this article is to stress on the importance of radiology in the timely diagnosis of such lesions, which can prevent the disaster not only to the patient but also to oral surgeon in legal and professional aspects.

Intraosseous hemangiomas are uncommon benign vascular tumors. Here the authors report a case of intraosseous hemangioma of the radial shaft in a 2-year-old boy, surgically treated by tumor mass resection and application of calcium sulfate pellets with no signs of relapse over a 2-year follow-up. Moreover, the lesion healed with new bone formation, and the last plain radiographs suggested homogenous normal trabecular bone density. The radius grew in length and remodeled to an almost normal shape. Clinically, elbow flexion-extension and forearm pronation and supination were within normal limits at the last follow-up visit. This report points to calcium sulfate pellets as a valid alternative to autologous bone grafting as void filler in large bone defects. Calcium sulfate pellets enable fast osteoinduction without interfering in follow-up imaging. [ABSTRACT FROM AUTHOR]

We describe a case of an epiphyseal hemangioma in the humeral head of a 20-year-old man. On plain radiographs, the lesion showed no gross abnormality. The computed tomography images demonstrated the presence of an irregular and lobulating osteolytic lesion with a peripheral sclerotic rim and focal cortical defects. The magnetic resonance images showed an ill-defined low signal intensity on T1-weighted images and mixed low and high signal intensities on T2-weighted images. Additionally, ill-defined marrow enhancement with inner low signal lines was noted in this lesion. The patient was treated with curettage and a bone chip graft. The present case is instructive in the differential diagnosis of epiphyseal bone tumors; furthermore, the possibility of an intraosseous hemangioma should also be considered. [ABSTRACT FROM AUTHOR]

The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date. [ABSTRACT FROM AUTHOR]

Intraosseous hemangioma (IH) is commonly seen in the vertebral column and skull: however, IH occurring in the appendicular skeleton, including the clavicle, is uncommon. We herein report the case of a 69-year-old female presenting with IH of the left clavicle. The findings of preoperative imaging studies, including radiographs, computed tomography (CT), magnetic resonance imaging, fluorine-18-fludeoxyglucose ( 18F-FDG) positron emission tomography (PET)/CT and ultrasonography, are described. In particular, 18F-FDG PET/CT showed an ill-defined osteolytic lesion with abnormally high FDG uptake. Surgical en bloc resection with preoperative embolization was carried out and a histopathological examination confirmed the presence of an intraosseous cavernous hemangioma in the clavicle. [ABSTRACT FROM AUTHOR]

Objective: We performed a retrospective study of the imaging findings of 15 patients (nine female, six male, mean age 43 years) with the histopathological diagnosis of hemangioma. Materials and methods: Radiographs, magnetic resonance imaging (MRI), computed tomography, and bone scan were performed. Results: Lower extremity was involved in nine cases, upper extremity in three cases, the acetabulum in two cases and the ilium in one case. Fourteen of the lesions were intramedullary and one was subperiosteal. Radiographs identified the lobular osteolytic intramedullary lesions with sclerotic margins (eight cases) and coarse linear trabeculation (four cases) or matrix ossification (one case) within it or a heavily calcified lesion (one case). Lesion expanded and breached the cortical cortex in four cases. The subperiosteal hemangioma presented as a soft tissue mass with proximal periosteal reaction. MRI also identified the soft tissue mass in the case of the subperiosteal hemangioma. The CT scan demonstrated the lobular osteolytic lesions, the prominent trabeculation and matrix mineralization and evaluated the cortex. In all six cases, the lesion showed increased uptake in the bone scan. Conclusions: This is the largest reported series of imaging features of intraosseous hemangiomas of appendicular skeleton. The lesion should be differentiated from other chondral or expansile lytic tumors. The final diagnosis can only be confirmed by histopathology. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Osteolytic calvarial lesions are infrequent findings. Some cases are found incidentally during cancer staging or subsequent to unspecific symptoms. There are no standardized algorithms for the treatment of such lesions. Thus, the aim of this study was to describe the clinicopathological features and surgical outcome in various osteolytic calvarial lesions. Material and methods: The clinical presentation, radiological imaging findings, surgical treatment and histopathological findings of 36 patients who underwent surgery for an osteolytic calvarial lesion at our institution between 1998 and 2008 were reviewed. Results: Thirty-six osteolytic calvarial lesions were identified in 20 men and 16 women. Mean age at diagnosis was 37 years. Ten patients were children younger than 15 years. Five lesions were detected during cancer staging. Complete removal of the calvarial lesions was achieved in all patients without complications. The most common histopathological diagnosis was metastasis (n =9), Langerhans-cell histiocytosis (n =9), and intraosseous hemangioma (n =5). In two asymptomatic patients, histopathological findings revealed metastases of a previously unknown tumor. In two other patients known to suffer from cancer, histopathological findings indicated intraosseous hemangioma and intraosseous meningioma, respectively. Reconstruction of the calvarial defect was performed in 24 cases with poly-methyl-methacrylate and with titanium mesh in 1 case. Conclusions: Osteolytic calvarial lesions can be found in any age group. The histopathological examination reveals various entities, and in some instances it was not concurrent with a primary malignancy. Because surgical morbidity is low, we recommend complete resection of osteolytic calvarial lesions with reconstruction when feasible. [ABSTRACT FROM AUTHOR]

The authors report a case of Plexiform ameloblastoma which is showing numerous vascular proliferation in the right mandible of an 15 year old Indian male who suffered from painful swelling for 2 months. A radiograph showed a well circumscribed multilocular radiolucent lesion with a impacted third molar associated with the angle and ramus of the mandible. Microscopic examination revealed the interlacing strands of ameloblastic epithelium with interspersed connective tissue stroma showing abundant endothelial lined & engorged vascular spaces. The possible pathogenesis for hemangiomatous appearance of this case may be previous history of fine needle aspiration cytology. [ABSTRACT FROM AUTHOR]

Intraosseous hemangioma, especially in the zygomatic area, is a very rare pathologic condition among the osseous tumors of the head and neck area. Clinical presentation includes a painless mass with progressive growth and hard consistence. Diagnosis is performed by means of computed tomography (CT). Treatment includes radical en bloc surgical excision with healthy bone margins in order to avoid blood loss. Previous embolization is not necessary. Bony defect reconstruction must be performed to avoid secondary deformities. We present a case report of a 30-year-old female presenting a progressive painless swelling in the malar and zygomatic regions. CT scan demonstrated a right zygomatic lesion that extended into the orbital floor and lateral orbital wall, affecting also the zygomatic arch. The biopsy revealed an intraosseous hemangioma. Treatment was performed including an en bloc resection with healthy bony margins and primary reconstruction with calvarian bone graft in association with galea–pericranium flap. [ABSTRACT FROM AUTHOR]

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Hemangioma can arise in the soft tissues and bone of the nasal cavity. However, to the best of our knowledge, there are no prior case reports presenting intraosseous hemangioma of the nasal septum. Intraosseous hemangioma, in addition to a chondroid tumor, should be included in the differential diagnosis of a calcified mass of the nasal cavity. In the present report, we present a case of an intraosseous cavernous hemangioma in the nasal bony septum of a 53-year-old woman. [ABSTRACT FROM AUTHOR]

Abstract: Hemangiomas mostly arise from the soft tissues, and intraosseous hemangiomas are uncommon. They usually occur in the vertebra and skull bones, and intraosseous hemangioma of the nasal cavity is exceedingly rare. We describe a 56-year-old woman who was referred to our hospital with a tumor in her right nasal cavity, without subjective symptoms such as epistaxis. The tumor was located at the front end of the right middle turbinate. Enhanced computed tomography demonstrated a 3cm×2cm expansive bony tumor replacing the bottom of the right middle turbinate with some partial enhancement effects. The characteristic honeycomb appearance was observed. The tumor and right middle turbinate were excised en bloc by the endoscopic endonasal approach. No complications or severe bleeding occurred during the peri-operative period. Histological examination showed endothelium-lined blood-filled vascular spaces within the bony trabeculae, which suggested the typical pattern of intraosseous cavernous hemangioma. To the best of our knowledge, this is the first case report of intraosseous cavernous hemangioma of the middle turbinate in the English literature. [Copyright &y& Elsevier]

Hemangiomas are benign tumors of the capillary endothelium involved in varied clinical and pathologic entities. Congenital hemangioma is quite rare compared to infantile hemangioma. Hemangiomas rarely occur in bone. Intraosseous hemangiomas are most commonly found in the vertebral column and skull. The mandible is the most frequently affected skull bone. Intraosseous hemangiomas commonly present in the second decade of life. Here, we report a neonate with noninvoluting congenital hemangioma of the mandible. To our knowledge, she is the youngest patient reported in the literature. [ABSTRACT FROM AUTHOR]

We report on a rare case of an intraosseous hemangioma involving the proximal tibia in a 70-year-old man. Radiographically, the lesion was a well-defined osteolytic lesion with marginal sclerosis. The CT images demonstrated a well-defined osteolytic lesion with partial cortical breakthrough. T1-weighted MR images showed a hypointense lesion, while T2-weighted images revealed hyperintense areas, with internal, hypointense septa. Gadolinium-enhanced T1-weighted images showed lattice-like enhancement of the lesion. [ABSTRACT FROM AUTHOR]

We report a rare case of a cavernous hemangioma involving the frontal bone in a 35-year-old woman. The patient had a headache and a lump in the left frontal region of her head. Computed tomography revealed lucency and widening of the diploe of the frontal bone. Surgical removal of the lesion was performed. [ABSTRACT FROM AUTHOR]