Hemangioma of skeletal muscle

Abstract

Intramuscular hemangiomas are rare benign tumors, making up 0.8% of all hemangiomas. They are of interest to the surgeon because their location may present considerable therapeutic challenge since radiographic work-up of the soft- tissue mass by magnetic resonance imaging (MRI) may be suspicious for malignancy. The definitive diagnosis is made by histological study of the surgical and/or biopsy specimen. Patients with intramuscular hemangiomas may have soft-tissue complaints, such as pain and swelling, present for years. The gross and microscopic appearance of intramuscular hemangiomas is variable. Grossly, the capillary type is nonvascular and spongy in appearance, whereas the cavernous type is composed of large, thin-walled, dilated vessels lined by flattened endothelial cells. In general, wide excision is the treatment of choice to prevent local recurrence, but every patient with intramuscular hemangioma should be treated individually after evaluating the tumor location, accessibility, and depth of invasion, the patient's age, and cosmetic considerations. From October 1, 1989, to June 30, 1997, 11 patients underwent surgical treatment with the definitive histological diagnosis of intramuscular hemangioma. Pain upon activity but also at rest as well as swelling were the major symptoms. The average duration of symptoms was 13 months (range 1 month to 5 years). After a mean follow- up of 3 years and 4 months (range 12 months to 9 years), one of the patients has developed a recurrence; all remaining patients enjoy pain relief without any recurrence.

Extremity localized intramuscular hemangiomas, follow up or surgery?

“…İntramusküler hemanjiom ilk kez 1843'te Liston tarafından tanımlanmış, Virschow ise 1867'de ilk vertebral hemanjiom vakasını yayınlamıştır (6,8 (11). Aktivite sonrası artış gösteren kronik ekstremite ağrısı ile yeni ele gelen kitle varlığı intramüsküler hemanjiomlar için tipiktir.…”

“…Bazı seçilmiş vakalarda çoklu lezyon içi skleroterapi uygulamasında başarılı sonuçlar elde edilmiştir. Kortikosteroid kullanımı ve radyoterapi ise primer olarak sistemik hastalıklarda tercih edilmekte olup intramüsküler hemanjiomlarda nadiren kullanılmaktadır ( 11,16).…”

Ethanol Sclerotherapy Reduces Pain in Symptomatic Musculoskeletal Hemangiomas

“…Sclerotherapy has been recognized for decades as a less morbid treatment option, with ethanol being the most common sclerosant [14,16]. However, most reports have focused on superficial lesions and their cosmetic consequences [6,8,14], with few dealing exclusively with deep musculoskeletal lesions [7,13] and the effectiveness of sclerotherapy in pain relief [7,9]. We sought to investigate the impact of sclerotherapy on pain relief, identify characteristics influencing its effectiveness, report size change induced by sclerotherapy, and describe observed complications.…”

“…Some authors have cited recanalization and neovascular recruitment as cause for increasing symptoms and suggest serial injections for maximal results [7,9,17]. If the presence of a mass is concerning to the patient and marginal excision can be achieved without sacrificing function, surgical excision then may be warranted, with a reported recurrence rate less than 10% [1,3,13].…”

“…However, the rate of recurrence after incomplete excision is reportedly as much as 18% to 50% [1,4,15] and tumor remnants can grow aggressively, causing symptoms even worse than before surgery [17]. If complete excision can be achieved, the recurrence rate is reportedly as low as 0% to 9% [1,3,13], but complications such as fibrosis and muscle weakness are common after surgery [7].…”