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CASE REPORT
Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 25-27

Haemangioma of tongue: A rare case report


Department of Radio Diagnosis, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India

Date of Web Publication18-Feb-2015

Correspondence Address:
Dr. Deepak Agrawal
Department of Radio Diagnosis, Era's Lucknow Medical College, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-3841.151645

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  Abstract 

Vascular anomalies include a wide range of tumors and malformations. Among vascular anomalies, hemangioma is the most common. Hemangioma is considered as hamartomatous lesion, and half of these have predilection for head and neck region, but rarely seen in the oral cavity. Here, we report a case of hemangioma in the posterior third of the tongue in a 10-year-old female, which appeared localized well defined, reddish pink and lobulated mass with well-defined margins on intra-oral examination. A well-defined homogeneously hyperechoic space occupying lesion (measuring = 4.4 cm × 4.2 cm) seen on ultrasonography which showed abnormally increased vascularity on color Doppler suggesting a vascular etiology. Further evaluation was done on contrast enhanced computed tomography scan and magnetic resonance imaging, which confirms its vascular nature and diagnosed as a case of hemangioma.

Keywords: Doppler, hemangioma, tongue, ultrasonography, vascularity


How to cite this article:
Khanduri S, Agrawal D, Varshney G, Singh N. Haemangioma of tongue: A rare case report. J Oral Maxillofac Radiol 2015;3:25-7

How to cite this URL:
Khanduri S, Agrawal D, Varshney G, Singh N. Haemangioma of tongue: A rare case report. J Oral Maxillofac Radiol [serial online] 2015 [cited 2019 Apr 25];3:25-7. Available from: http://www.joomr.org/text.asp?2015/3/1/25/151645


  Introduction Top


Hemangioma (Greek: Haima-blood; angeion-vessel, oma-tumor) is defined as a tumor of dilated blood vessels. They are most common vascular tumors of infancy and childhood. [1],[2] Hemangioma are of two types-capillary and cavernous. They appear in the 1 st month of life and are characterized by rapid proliferative phase and slow involution, to near spontaneous resolution. Nearly 60-70% of the lesions are found in head and neck. [3]

Hemangiomas can also be described according to the vessel involved or flow type like arterial or arteriovenous type (high flow) or capillary or venous type (slow flow). [4]


  Case Report Top


A 10-year-old girl visited our hospital for a localized swelling on the posterior third of the tongue. The swelling was present since 1½ years back, it was small at first but gradually increased in size. Patient had difficulty in swallowing and breathing due to the swelling no history of pain, fever, and bleeding was present. On general examination, the built of the patient was normal for age, and all the vitals were normal. No relevant medical, dental and family history was present.

Intra-oral examination revealed a localized well defined, reddish pink and lobulated mass with well-defined margins in the posterior third of the tongue extending up to the right tonsilo-lingular sulcus measuring approximately (5 cm × 6 cm) [Figure 1]. The surface was smooth with fine granularity. On palpation, it was soft to firm in consistency nonmobile, afebrile, nontender with no thrill and blanched on application of pressure. Routine blood, urine and thyroid profile were normal. On X-ray lateral view skull showed increased soft tissue shadow in the oropharynx. On high resolution ultrasonography of tongue through submandibular approach revealed a well-defined homogeneously hyperechoic space occupying lesion (SOL) (measuring = 4.4 cm × 4.2 cm) in the posterior third of tongue, the SOL showed abnormally increased vascularity on color Doppler suggesting a vascular etiology [Figure 2]. On computed tomography (CT) scan of neck, a well-defined moderate sized homogenously iso to hyperdense SOL with clear margins which showed strong homogenous enhancement on post contrast scans [Figure 3], involving the base of the tongue and floor of mouth causing narrowing of the oropharyngeal region extending posteriorly up to the pre styloid parapharyngeal space, no evidence of any bony destruction was noted. On magnetic resonance imaging (MRI) a well-defined rounded area of signal alteration iso to hypointense on T1-weighted, hyper-intense on T2-weighted with multiple serpiginous flow voids with strong homogenous enhancement on contrast with marked enhancement of intra-tumoral vessels is noted at the base of tongue extending up to the oropharynx [Figure 4]. Excision of the lesion was done with no postoperative complications. With all the investigations, a diagnosis of hemangioma of tongue was concluded.
Figure 1: A 10-year-old girl with lobulated mass in posterior half of tongue diagnosed as hemangioma. Photographic image shows a well-defined, reddish pink lobulated mass (black arrow) with well-defined margins and smooth surface in the posterior third of the tongue extending up to the right tonsilo-lingular sulcus


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Figure 2: A 10-year-old girl with lobulated mass in posterior half of tongue diagnosed as hemangioma. Transverse high resolution ultrasonography of tongue through submandibular approach revealed a well-defined homogeneously hyperechoic space occupying lesion (SOL) in the posterior third of tongue (large arrow) and the Sol showed abnormally increased vascularity on color Doppler suggesting a vascular etiology (small arrow)


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Figure 3: 10-year-old girl with lobulated mass in posterior half of tongue diagnosed as hemangioma. On computed tomography scan of neck, axial images shows a well-defined moderate sized homogenously iso to hyperdense space occupying lesion (large arrow) with clear margins with strong homogenous enhancement on postcontrast scans (small arrow) was noted


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Figure 4: 10-year-old girl with lobulated mass in posterior half of tongue diagnosed as hemangioma. On magnetic resonance imaging, sagittal images shows a well-defined rounded space occupying lesion with serpiginous flow voids representing the intra tumoral vessels showing area of signal alterations iso to slightly hyperintense on T1-weighted image (large arrow), hyperintense on T2-weighted (small arrow) and homogenous enhancement on postcontrast T1-weighted images (star)


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  Discussion Top


Hemangiomas are common developmental vascular abnormalities, head and neck regions are more commonly involved mainly face, lips and oral mucosa, but the tongue is rarely involved as in our case report. The term "hemangioma" is misused for various vasculoformative tumors, for this confusion, the International Society for the Study of Vascular Anomalies has recently provided guidelines to differentiate these two conditions, according to the novel classification first published by Mulliken and Glowacki in 1982. [5] Now vasculoformative tumors are divided into Hemangioma and vascular malformations. Hemangiomas are benign tumors of endothelial cells and are of two types capillary and cavernous hemangioma. Histologically hemangiomas are classified as capillary and cavernous types. A capillary hemangioma also called as "strawberry" birthmark consists of an abnormal overgrowth of tiny blood vessels. Capillary hemangiomas may not be present at birth but appear within the first 6 months of life. They usually begin to decrease in size between 12 and 15 months of age. Most regress nearly completely by 5 or 6 years of age. Capillary hemangiomas are more common in premature infants and in girls while cavernous hemangioma is a benign, congenital red or purple tumor consisting of enlarged blood vessels. The scalp, face, and neck are the most common sites, but these tumors have been found in the liver and other organs. Superficial cavernous hemangiomas are friable and easily infected if the skin is broken. Treatment includes observation, irradiation, sclerosing solutions, and laser surgery and excisional surgery. Cavernous hemangiomas are also called as angioma cavernosum, cavernoma. [6] Hemangiomas are dark red to purplish blue, may be superficial or deep, may be sessile or pedunculated, they blanch on application of pressure, can vary from millimeters to centimeters in size. [7],[8]

Radiological investigations are mainly done if the tumor is compressing a vital anatomical structure like a nerve or a vessel. CT and MRI are used for assessing the volume of hemangiomas and vascular malformations and can also help to differentiate the tumor from its differentials and also help in assessing the its size, extension and location, as well as for follow-up after treatment. Color Doppler can help in differentiating between vascular and nonvascular lesions and can help to localize the feeding vessel, further helping in concluding the treatment plan. Baba and Kato reported a case of hemangioma with pleboliths in the floor of the mouth and Doppler ultrasonography, CT, MRI was used to diagnose the lesion. [3]

Hemangiomas are found in association with various syndromes like Osler - Webber - Rendu syndrome, Sturge - Webber syndrome and Blue rubber bleb nevus syndrome. Differential diagnosis in our case could be lingual thyroid, thyroglossal duct cyst, lymphangioma, hypertrophy of ligular tonsils, dermoid and lipoma. The presence of vascularity in hemangioma differentiates it from the above condition.

Hemangioma of tongue needs special consideration due to susceptibility to trauma, bleeding and ulceration, it may also become a cause of difficulty in breathing and dysphagia.

Most of the haemangiomas are asymptomatic and can be treated conservatively. If symptoms like mass effect, dysphagia, dyspnea or haemorrhage are present then symptomatic lesions should, when possible, be resected which is curative. Different treatment modalities are available like intralesional and systemic corticosteroids, sclerosing agents, embolization, excision (as in our case), electrolysis, thermacautry and laser photocoagulation. Now a day's sclerosing therapy is employed due to its efficacy and ability to not destroy surrounding tissue. [9]


  Conclusion Top


A rare case of hemangioma in the posterior third of tongue in a 10-year-old female which appeared localized well defined, reddish pink and lobulated mass with well-defined margins on intra-oral examination with typical features on ultrasonography and abnormally increased vascularity on color Doppler suggesting a vascular etiology. Further evaluation was done on contrast enhanced CT scan and MRI which confirms its vascular nature and diagnosed as a case of hemangioma.

 
  References Top

1.
Maaita JK. Oral tumors in children: A review. J Clin Pediatr Dent 2000;24:133-5.  Back to cited text no. 1
    
2.
Tanaka N, Murata A, Yamaguchi A, Kohama G. Clinical features and management of oral and maxillofacial tumors in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:11-5.  Back to cited text no. 2
    
3.
Okoje VN, Alonge TO, Olusanya AA. Intra-tumoral ligation and the injection of sclerosant in the treatment of lingual cavernous haemangioma. Niger J Med 2011;20:172-5.  Back to cited text no. 3
    
4.
Greenberg M, Glick M, Ship JA, editors. Burkett's Oral Medicine, Diagnosis & Treatment. 11 th ed. Hamilton: BC Decker Inc.; 2008. p. 490-1.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Neville BW, Damm DD, Allen CM, Bouqot JR. Oral & Maxillofacial Pathology. 2 nd ed. Philadelphia, Pa, USA: WB Saunders; 2002.  Back to cited text no. 6
    
7.
Werner JA, Dünne AA, Folz BJ, Rochels R, Bien S, Ramaswamy A, et al. Current concepts in the classification, diagnosis and treatment of hemangiomas and vascular malformations of the head and neck. Eur Arch Otorhinolaryngol 2001;258:141-9.  Back to cited text no. 7
    
8.
Kutluhan A, Bozdemir K, Ugras S. The treatment of tongue haemangioma by plasma knife surgery. Singapore Med J 2008;49:e312-4.  Back to cited text no. 8
    
9.
Bonet-Coloma C, Mínguez-Martínez I, Palma-Carrió C, Galán-Gil S, Peñarrocha-Diago M, Mínguez-Sanz JM. Clinical characteristics, treatment and outcome of 28 oral haemangiomas in pediatric patients. Med Oral Patol Oral Cir Bucal 2011;16:e19-22.  Back to cited text no. 9
    


    Figures

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



 

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