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Year : 1991  |  Volume : 39  |  Issue : 2  |  Page : 76-77

Cavernous hemangioma of the frontal bone : A case report

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
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Source of Support: None, Conflict of Interest: None

PMID: 1916988

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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

How to cite this URL:
Aurora A, Krishnan MM, Bahadur R, Vidyasagar J, Ratnakar C. Cavernous hemangioma of the frontal bone : A case report. Indian J Ophthalmol [serial online] 1991 [cited 2023 Jun 10];39:76-7. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1991/39/2/76/24462

  Introduction Top

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 Top

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 Top

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 Top

Wyke B.D.. Primary hemangioma of the skull, a rare cranial tumor. The Am. J of Roentgenology and Radium therapy 61:302-16. 1949.  Back to cited text no. 1
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.  Back to cited text no. 2
Enneking W.F.. Muskuloskeletal tumor surgery: Vascular tumor. 1175­1191 Churchill Livingstone, London. 1983.  Back to cited text no. 3


  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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