Intraosseous Hemangioma with unusual presentation

Abstract

Intrabony vascular lesions are extremely rare conditions. The lesions include 0.5% to 1% of all intraosseous tumors. Females are more predilected than males with a female: male ratio of 2:1, usually affecting the second decade of life. Most common sites of occurrence of these lesions are in the vertebral column and skull, jaws are the rare location with the mandible being the quite rare location. The origin of hemangiomas is still doubtful. Many of the authors believe it as hamartoma but as per World Health Organization, it as a true benign neoplasm of vascular origin. The clinical presentation of hemangiomas is variable with atypical radiographic presentations. Due to the varied presentations of this lesion, the diagnosis becomes very difficult. But diagnosing central hemangiomas early is essential for preventing uncontrollable hemorrhage and even death during any surgical intervention. We present a case of intraosseous cavernous hemangioma which presented as periapical radiolucency with specks of calcification, quiet a rare presentation. The case was managed by embolization followed by surgical resection of the body of the mandible.

Challenges and Management of Capillary Intraosseous Hemangioma in the Mandibular Symphysis: A Case Report

“…The pathogenesis of hemangiomas remains up for debate, with several theories proposed to explain their development. Some authors propose that hemangiomas are congenital lesions, while others attribute their development to trauma [2,13,15]. However, no history of trauma or predisposition for the development of intraosseous hemangioma was identified in our case.…”

“…Hemangioma is a clinical term used to describe a benign vascular neoplasm of endothelial origin. Histologically, based on the type of blood vessels involved, it can be classified as capillary, cavernous, or mixed [13][14][15].…”

“…Diagnosing this condition can pose challenges, given that patients are typically asymptomatic, and its discovery often occurs incidentally during routine radiographic examinations [14]. Nevertheless, some patients may report symptoms, including pain or discomfort, paresthesia, facial asymmetry, and teeth mobility [15,16]. Initially, the patient's clinical presentation did not align with the typical characteristics of a bone hemangioma.…”

“…This overlap in features can make it challenging to definitively identify the condition. These lesions may manifest as a multilocular radiolucency, presenting a honeycomb or soap bubble pattern, or as an unilocular radiolucency [6,15]. CT scan and magnetic resonance angiography (MRA) are also valuable tools for the etiological assessment and staging of the lesion, as highlighted in the literature [13].…”

“…Otherwise, a wait-and-see approach is preferred due to the benign nature of these lesions [2,13]. Surgical excision with reconstruction stands as the ideal treatment, while alternative therapeutic modalities such as curettage, radiotherapy, and embolization are also viable options [15]. The utility of preoperative embolization is evident in cases involving large lesions, where its purpose is to minimize surgical bleeding [15].…”