Intracranial extension of an intramuscular haemangioma of superior rectus: case report and literature review

Abstract

Background Intramuscular haemangiomas are rare, benign vascular tumours that represent < 1% of all haemangiomas. When involving the extraocular muscles, haemangiomas are extremely rare, with only nine cases reported in the literature; to date there are no reported cases of extraocular muscle haemangiomas extending into the brain. Case presentation A 6-year-old boy with a two-week history of a painless swelling and erythema on the upper eyelid. On examination, the patient had restricted extraocular motility in all directions of gaze. In addition, the eye appeared proptotic, with chemosis and hyperaemia of the conjunctiva. Visual acuity and intraocular pressure were normal. Orbital computed tomography imaging showed a mass in the left superior rectus, with heterogeneous enhancement following contrast administration. Incisional biopsy revealed an intramuscular haemangioma of the superior rectus muscle with capillary-type vessels. The patient received an intralesional steroid, which improved the condition for a few months; however, the lesion later recurred and included an intracranial extension. Conclusion This case represents the first reported case of intracranial extension of intramuscular haemangioma of extraocular muscle.

Intramuscular Hemangioma of Lateral Rectus Muscle with Rare Presentation as an Epibulbar Mass: A Case Report and Review of Literature

“…They are congenital, slow-growing masses that often remain undetected until later decades when they become symptomatic [ 2 ]. To date, only eleven cases of hemangiomas involving EOMs have been reported in literature [ 1 – 10 ]. The commonest clinical presentation reported was painless, progressive proptosis (seen in 10 cases); other symptoms included eyelid swelling (5 cases), ocular movement restriction (3 cases), and diplopia (1 case) [ 1 – 10 ].…”

“…To date, only eleven cases of hemangiomas involving EOMs have been reported in literature [ 1 – 10 ]. The commonest clinical presentation reported was painless, progressive proptosis (seen in 10 cases); other symptoms included eyelid swelling (5 cases), ocular movement restriction (3 cases), and diplopia (1 case) [ 1 – 10 ]. The location of the IMH can lead to further complications.…”

“…Visual acuity may be decreased in cases where the tumor encases the optic nerve, causing mechanical compression [ 3 , 5 , 8 ]. In one reported case, the tumor even caused bony erosion of the orbital roof with intracranial extension [ 10 ].…”

“…Histologically, IMHs are classified into capillary, cavernous, and mixed types, comprising 50%, 29%, and 21% of all cases, respectively, with the capillary type being commonest in the head and neck region [ 1 , 2 ]. On reviewing the existing literature on IMHs of EOMs, histopathological classification was available in ten of the eleven reported cases [ 1 , 3 – 10 ]. Including this case, capillary, cavernous and mixed types were seen in 27.3%, 45.5%, and 27.3% of cases, respectively.…”

“…Of these, only 15% occur in the head and neck muscles, the commonest muscle involved being the masseter [ 1 , 2 ]. Extraocular muscle (EOM) involvement is especially rare with only a few cases reported in literature [ 1 – 10 ]. Patients with IMH of EOM commonly present with proptosis due to intra-orbital tumor location, and diagnosis is mainly based on orbital MRI findings with histopathological confirmation.…”