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Cavernous hemangioma of the auricle
CLINICAL PHOTOGRAPHS MICHAEL A. KEEFE, MD, CDR MC USN Clinical Photographs Editor
Cavernous hemangioma of the auricle Ö. TASKIN ¸ YÜCEL, MD, Ankara, Turkey
A
40-year-old woman was admitted to our clinic for treatment of the physical appearance and pulsation of a mass in her right auricle (Fig 1). The mass had been present since birth; however, in recent years the pulsatile characteristic of the lesion had become more annoying. The lobule portion of the auricle particularly bothered her. Surgical resection of the auricle was performed. The arteries and veins were first ligated, the lobule resected, and the auricle then reconstructed. A CO2 laser was used to decrease the volume of the lesion at the helix and antihelix of the auricle. Venous thrombosis that occurred a few days after the procedure resolved with conservative therapy. The histopathologic diagnosis was cavernous hemangioma. Hemangiomas and vascular malformations are the most frequently observed benign tumors of infants and children. More than 50% of these tumors originating from blood vessels or vascular structures are located in the head and neck region. Hemangiomas are characterized by development after birth and have a tendency to proliferate, regress, and have specific endothelial characteristics that allow differentiation from vascular malformations.1 In contrast, vascular malformations are usually noted at birth, grow according to body volume, and do not have a tendency to regress.2 Cavernous hemangioma is usually an irregular, soft, bright red or deep purple papular nodular mass that is easily compressible. It increases in size when the patient strains or when there is an increase in intracranial pressure. Some lesions are associated with occult internal hemangioma or spinal cord arteriovenous malformations. When both superficial and deep elements are present, the lesion is referred to as a mixed hemangioma. Because of the high rate of spontaneous regression of
This section is made possible through an educational grant from AstraZeneca, LP, makers of Rhinocort Aqua. From the ENT Department, Hacettepe University. Reprint requests: Ö. Ta¸skin Yücel, MD, Hosdere Cad. No 49/13, 06540 Y. Ayranci, Ankara, Turkey. Otolaryngol Head Neck Surg 2000;122:153. Copyright © 2000 by the American Academy of Otolaryngology– Head and Neck Surgery Foundation, Inc. 0194-5998/2000/$12.00 + 0 23/11/99276
hemangiomas, most physicians tend not to treat them primarily. However, complications such as bleeding, compression symptoms, pain, and psychological stress resulting from cosmetic deformity may warrant intervention. Many treatment modalities for hemangioma therapy have been advocated. Conventional surgery, embolization, and steroid therapy are standard procedures in many hospitals, whereas chemotherapy and interferon therapy are reserved for more severe conditions.3 Laser therapy of these lesions has also been reported to be successful in recent years. Radiotherapy of hemangiomas, often chosen as first line of therapy in the past, is currently obsolete as a standard treatment because of the extensive influence on skeletal growth and the occurrence of radiogenic malignancies. REFERENCES 1. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982;69:412-22. 2. Yücel ÖT, Genç E, Kaya S. A venous anomaly of the neck. Int J Pediatr Otorhinolaryngol 1997;42:81-9. 3. Rebeiz E, April MM, Bohigian RK, et al. Nd-YAG laser treatment of venous malformations of the head and neck: an update. Otolaryngol Head Neck Surg 1991;105:655-61.
Fig 1. Hemangioma of the auricle.
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Cavernous hemangioma of the auricle Ö. TASKIN ¸ YÜCEL, MD, Ankara, Turkey
A
40-year-old woman was admitted to our clinic for treatment of the physical appearance and pulsation of a mass in her right auricle (Fig 1). The mass had been present since birth; however, in recent years the pulsatile characteristic of the lesion had become more annoying. The lobule portion of the auricle particularly bothered her. Surgical resection of the auricle was performed. The arteries and veins were first ligated, the lobule resected, and the auricle then reconstructed. A CO2 laser was used to decrease the volume of the lesion at the helix and antihelix of the auricle. Venous thrombosis that occurred a few days after the procedure resolved with conservative therapy. The histopathologic diagnosis was cavernous hemangioma. Hemangiomas and vascular malformations are the most frequently observed benign tumors of infants and children. More than 50% of these tumors originating from blood vessels or vascular structures are located in the head and neck region. Hemangiomas are characterized by development after birth and have a tendency to proliferate, regress, and have specific endothelial characteristics that allow differentiation from vascular malformations.1 In contrast, vascular malformations are usually noted at birth, grow according to body volume, and do not have a tendency to regress.2 Cavernous hemangioma is usually an irregular, soft, bright red or deep purple papular nodular mass that is easily compressible. It increases in size when the patient strains or when there is an increase in intracranial pressure. Some lesions are associated with occult internal hemangioma or spinal cord arteriovenous malformations. When both superficial and deep elements are present, the lesion is referred to as a mixed hemangioma. Because of the high rate of spontaneous regression of
This section is made possible through an educational grant from AstraZeneca, LP, makers of Rhinocort Aqua. From the ENT Department, Hacettepe University. Reprint requests: Ö. Ta¸skin Yücel, MD, Hosdere Cad. No 49/13, 06540 Y. Ayranci, Ankara, Turkey. Otolaryngol Head Neck Surg 2000;122:153. Copyright © 2000 by the American Academy of Otolaryngology– Head and Neck Surgery Foundation, Inc. 0194-5998/2000/$12.00 + 0 23/11/99276
hemangiomas, most physicians tend not to treat them primarily. However, complications such as bleeding, compression symptoms, pain, and psychological stress resulting from cosmetic deformity may warrant intervention. Many treatment modalities for hemangioma therapy have been advocated. Conventional surgery, embolization, and steroid therapy are standard procedures in many hospitals, whereas chemotherapy and interferon therapy are reserved for more severe conditions.3 Laser therapy of these lesions has also been reported to be successful in recent years. Radiotherapy of hemangiomas, often chosen as first line of therapy in the past, is currently obsolete as a standard treatment because of the extensive influence on skeletal growth and the occurrence of radiogenic malignancies. REFERENCES 1. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982;69:412-22. 2. Yücel ÖT, Genç E, Kaya S. A venous anomaly of the neck. Int J Pediatr Otorhinolaryngol 1997;42:81-9. 3. Rebeiz E, April MM, Bohigian RK, et al. Nd-YAG laser treatment of venous malformations of the head and neck: an update. Otolaryngol Head Neck Surg 1991;105:655-61.
Fig 1. Hemangioma of the auricle.
153