Intraosseous hemangioma - calvarial
History of non-tender forehead swelling which grew over the last 2 months. No history of trauma.
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Well-defined expansive lytic lesion is seen affecting the right frontal bone with typical coarsened trabeculation and characteristic sunburst pattern radiating from the center.
The erosive changes of the external skull table seen. An overlying focal galeal contour bulge was noted.
No intraparenchymal component could be depicted. No soft tissue component could be seen.
No other similar lesions could be seen.
Intraosseous hemangioma accounts for about 0.7% of all bone tumors. It is considered as a rare bone tumor. It can present at any age; however, it is commonly seen between fourth and fifth decades. 1 The cause is unknown; it could be congenital or traumatic. 2
Patients may present with slow-growing palpable hard mass as in our case with mild tenderness. Neurological deficit is uncommon as mass grows externally rather than internally. 3
Radiologically interosseous hemangioma presents as an osteolytic lesion. CT is the modality of choice to check interosseous extent and soft tissue involvement; however, it is difficult to make definitive diagnosis radiologically only, as many differential diagnoses may be raised like Langerhans cell histiocytosis, osteoma and fibrous dysplasia. 4
In CT fibrous dysplasia will show ground glass appearance which may help to differentiate between it and interosseous hemangioma which will show thickened trabeculae with a sunburst pattern.
Treatment of choice is en bloc resection with a safe margin of normal bone. Other therapies like embolization, curettage and radiotherapy may help.4
Special thanks to Dr Tamer Ibrahim ElHoliby.
- Cheng NC, Lai DM, Hsie MH, et al. Intraosseous hemangiomas of the facial bone. Plast Reconstr Surg. 2006;117:2366–2372. PMID: 16772943 DOI: 10.1097/01.prs.0000218818.16811.9b
- Liu JK, Burger PC, Harnsberger HR, et al. Primary intraosseous skull base cavernous hemangioma: case report. Skull Base. 2003;13:219–228. PMID: 15912181 PMCID: PMC1131855 DOI: 10.1055/s-2004-817698
- Primary Intraosseous Hemangioma in the Frontal BoneByung Ho Park, Euna Hwang, and Chung Hun Kim. Arch Plast Surg. 2013 May; 40(3): 283–285. PMID: 23730614 PMCID: PMC3665882 DOI: 10.5999/aps.2013.40.3.283
- Heckl S, Aschoff A, Kunze S. Cavernomas of the skull: review of the literature 1975-2000. Neurosurg Rev. 2002;25:56–62 PMID: 11954766