HEMANGIOMA CAPILAR INTRAÓSEO

Abstract

Introduction and objective: Primary intraosseous hemangioma is a rare, benign and slow-growing bone tumor. These neoplasms tend to involve the vertebrae and the skull (more than 50% of cases). When they arise within the cranial vault, they are usually confined to the frontal or parietal bones. Orbital lesions occur infrequently. It should be taken into account in the differential diagnosis in those patients who present a fixed mass in the orbit or signs of progressive painless proptosis.These lesions are usually solitary and occur more frequently in women than in men, in a ratio of three to one. They are usually found in adults, although people of any age can be affected. Bony hemangiomas are of three histological types: cavernous, capillary and mixed.We present a case of intraosseous capillary hemangioma that affects left lamina papyracea with extension into the ethmoidal cell of posterior location.Material and Method: A 50-year-old woman with a clinical history of one and a half years of evolution characterized by a sensation of pressure in the left eye, no pain, no decrease in visual acuity, no double vision.Facial CT: Hyperdensa and well defined image, with a broad base dependent on the left papyracea lamina, which associates bone destruction, imprinting laterally towards the orbital region, conditioning displacement of the homolateral medial rectus; and medially extends towards the interior of the ethmoidal cell of posterior location.NMR: Image of occupation of left posterior ethmoidal cells that imprint on the medial wall of the left orbit and laterally displaces the internal rectus muscle, without data suggesting a muscle or soft tissue inflammatory process associated.Results: Endoscopic endonasal approach was proposed for exeresis of the lesion. Medium meatotomy and left ethmoidectomy were performed, localization of the lesion approximately 1.5 cm long located in the left posterior ethmoid, bleeding, with trabecular bone, which is introduced into orbit, adhering to the internal rectus muscle. An apparently complete tumor resection was performed.Pathological Anatomy: intraosseous capillary hemangioma.Control NMR (1 year after surgery): No significant orbital alterations. Small defect on more posterior region of the medial wall of the left orbit in relation to the background.Occupation by soft tissue signal of left posterior ethmoidal cells, without significant enhancement after administration of intravenous contrast in probable relationship with postoperative changes.Conclusions: The differential diagnosis of slow-growing primary bone lesions in the orbit is very wide, since there are a large number of lesions with clinical and radiographic presentation similar to bone hemangiomas.Most of the bone hemangiomas diagnosed in the head and neck are of the cavernous type and are a frequent cause of primary expansive lesion of the orbit, however in the case presented, the anatomopathological result has been of the capillary type.The pathogenesis of this neoplasm is unknown. Some consider them as vascular malformations of development, although previous trauma has also been implicated. Hemangiomas were originally classified as neoplasias of vascular origin, but today many authors consider hamartomatous malformations.When these orbital lesions are medial or inferior to the optic nerve, as in the case presented, an endonasal approach is possible, with complete resections and favorable evolution.