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| CASE REPORT |
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| Year : 1991 | Volume
: 39
| Issue : 2 | Page : 76-77 |
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Cavernous hemangioma of the frontal bone : A case report
Ajay Aurora1, Mathew M Krishnan2, Raj Bahadur3, JVS Vidyasagar3, Chaganti Ratnakar4
1 Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry- 685 006, India
2 Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
3 Department of Orthopaedics , Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
4 Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
Correspondence Address:
Ajay Aurora
D-1, Kaveri Apartments, Kalkaji, Alakhnanda, New Delhi - 110 019
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1916988 
Cavernous hemangioma of the frontal bone in a 15 year old girl which subsided after marginal resection (curettage) is presented. Keywords: Hemangioma
How to cite this article:
Aurora A, Krishnan MM, Bahadur R, Vidyasagar J, Ratnakar C. Cavernous hemangioma of the frontal bone : A case report. Indian J Ophthalmol 1991;39:76-7 |
| Introduction | |  |
Hemangiomas of the bone in general constitute about 0.7% while primary hemangiomata of the skull are only 0.2% of all the osseous neoplasms. These have been frequently recorded ion the fourth decade and are considered to be rare before the third decade. Amongst'the hemangiomata arising from the orbital bones the age has varied from 36 to 66 years [1],[2] .Amongst the skull bones, the parietal bone is most frequently involved'. In the present case the frontal bone was involved in a 15 year old girl, the features of this case were unusual and she surprisingly responded to limited curettage.
| Case report | | |
Miss. M, aged 15 years, attended the Ophthalmic outpatient of JIPMER hospital with a swelling of the left eyebrow of two years' duration. The swelling had been slowly and painlessly increasing in size without any visual impairment. There was no history of trauma.
On examination there was a hard, immobile swelling in the left frontal region (supraorbital area) which was non-tender and non-pulsatile. The skin over the swelling was freely mobile and there were no dilated veins. The anterior and posterior segments were normal except for a fullness of the upper eyelid and narrowing of the palpebral aperture [Figure - 1][Figure - 2].
Radiological Examination:
Postero-anterior projection of the skull [Figure - 3] reveals a thickened left frontal bone with a circumscribed, oval, radiolucerrt area showing honey-combing with fine trabeculae. A minimum hyperostosis is seen along the inferior and lateral margins of the radiolucent zone and the orbital cavity appears to be narrowed.
Lateral projection of she skull [Figure - 4] shows an expansion of the diploe which is extending into the left orbital plate of the frontal bone; the latter is hence expanded downwards, leading to narrowness of the orbital cavity.
Surgical findings: With a 5 cm long transverse supraorbital incisions the outer cortex of the frontal bone was nibbled. The tumor tissue which was found to be profuselv bleeding was curetted and the material sent for histopathology.
Histopathology: Sections taken from multiple greyish brown bits of tissue revealed spicules of bone enclosing large dilated spaces lined by a single layer of endothelial cells. Some of these vascular channels contained red blood cells [Figure - 5]. Histology was that of a cavernous hemangioma of bone.
| Discussion | | |
Hemangioma is believed to represent hamartomatous malformation of normal vascular tissue or a benign neoplasm [3]. They are exceptionally rare in bone [3]. Though commonest in the fourth decade, cases have been reported from the third week to 70 years of age [2].
Whether their origin is congenital or due to trauma is debatable [1]. Hemangiomas of the skull are mostly not associated with neurological symptoms as there is a tendency for external rather than internal expansion. However, in hemangiomas arising from the orbital bones, local symptoms like proptosis. diplopia and visual disturbances are frequent. Absence of these in the present case is notable. Roentgenographic appearance is more valuable than the clinical picture for diagnosis. This includes a round or oval area with honeycomb appearance without any osteosclerotic reaction. Tangential views in addition have a sun-ray appearance and may show erosion of the outer table.
The histopathology reveals the characteristic picture of a cavernous hemangiom of the bone. Duke-Elder mentions 3 cases of hemangiomas arising from orbital bones, of which only one case was of the capillary variety [2]. The present case too has followed the generalised pattern of histopathological preponderance.
Recurrence of hemangiomas after curettage is considered to be practically universal [3]. But in this case the eyebrow swelling subsided after curettage and did not recur till one year of follow-up. This may be due to an intralesional thrombotic process. We did not perform a radical excision of the tumor as it was not producing any pressure symptoms; it is virtually impossible to dissect between the periphery of the lesion and the surrounding normal tissue without inadvertent transection of occult extensions and hence a local recurrence is inevitable; hemangiomas are unknown to undergo malignant transformation.
| References | | |
| 1. | Wyke B.D.. Primary hemangioma of the skull, a rare cranial tumor. The Am. J of Roentgenology and Radium therapy 61:302-16. 1949.  |
| 2. | Duke Elder S.. Mc Faul P.A.. Vascular tumors. In: System of ophthalmology: Ocular adnexa part 2. Ed. Duke-Elder S. 1091. The C.V. Mosby company. St.Louis. 1974. |
| 3. | Enneking W.F.. Muskuloskeletal tumor surgery: Vascular tumor. 11751191 Churchill Livingstone, London. 1983. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
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