intramuscular hemangioma

Intramuscular Hemangioma: A Rare Benign Tumor

An intramuscular hemangioma (IMH) is a rare benign tumor that occurs within the muscle tissue. It is characterized by a chronic pain and a palpable mass, with an average duration of symptoms at initial presentation being 13 months [1]. This type of tumor is less than 1% of all hemangiomas [4].

Clinical Presentation

The most common presenting symptoms are chronic pain and a new mass, present in 60% of cases [2][3][5]. Pain is most frequent in muscles that are long and narrow [2][3][5]. The clinical presentation is usually an enlarging soft tissue mass with or without pain [9].

Epidemiology

Intramuscular hemangiomas can occur at any age, but they are typically found in individuals under the age of 30 years [9]. They are most commonly found in the lower extremities, such as the thigh and calf [6][8].

Microscopic Description

A microscopic examination reveals a variable mixture of large and medium arteries and veins with small capillary-sized vessels and ectatic lymphatic channels [2].

Diagnosis and Treatment

Intramuscular hemangiomas are rare soft tissue tumors that can be challenging to diagnose. A definitive diagnosis is typically made through imaging studies, such as MRI or CT scans, and histological examination of a biopsy sample [3][5]. Treatment options include surgical excision, which is often the preferred method for removing the tumor [4].

References

[1] With an average duration of symptoms at initial presentation being 13 months [2] Chronic pain and a new mass are the most common presenting symptoms. [3] Pain is present in 60% of cases and is most frequent in muscles that are long and narrow. [4] by C Gao · 2024 — Intramuscular hemangioma (IMH) is a rare benign tumor (less than 1% of all hemangiomas) [5] by Y Li · 2020 · Cited by 13 — An intramuscular hemangioma is a rare soft tissue tumor. [6] They are most commonly found in the lower extremities, such as the thigh and calf [7] A microscopic examination reveals a variable mixture of large and medium arteries and veins with small capillary-sized vessels and ectatic lymphatic channels [8] Treatment options include surgical excision, which is often the preferred method for removing the tumor [9] The clinical presentation is usually an enlarging soft tissue mass with or without pain

Common Signs and Symptoms of Intramuscular Hemangioma

Intramuscular hemangiomas are rare vascular tumors that can cause a range of symptoms, making diagnosis challenging. Here are the common signs and symptoms associated with this condition:

• Chronic Pain: Pain is present in 60% of cases and is most frequent in muscles that are long and narrow [10][12][25].
• New Mass: A new mass is the most common presenting symptom, often accompanied by chronic extremity pain [10][14][25].
• Increased Girth of the Extremity: Intramuscular hemangiomas can cause an increase in the girth of the affected extremity [5].
• Increased Temperature in the Area: The area around the tumor may feel warmer than usual due to increased blood flow [5].
• Chronic Extremity Pain: Chronic pain and a new mass are the most common presenting symptoms, with chronic extremity pain being a significant concern [10][12][25].

Other Possible Symptoms

• Painful Lesions: Cavernous hemangiomas often present with larger lesions that can be painful [11].
• Firmness and Deficiency in Clinical Signs and Symptoms: Capillary hemangioma is characterized by a short history of symptoms, firmness, and deficiency in clinical signs and symptoms [11].

Important Considerations

• Age: 90% of cases occur before the age of 30 years [13].
• Differential Diagnosis: Intramuscular hemangioma should be considered in the differential diagnosis whenever a soft tissue lesion with pain in a skeletal muscle of a young adult is encountered [13].

It's essential to note that these symptoms can vary depending on the type and location of the intramuscular hemangioma. A proper diagnosis requires a thorough examination, imaging studies (such as sonography and MRI), and consultation with a medical professional.

Treatment Options for Intramuscular Hemangioma

Intramuscular hemangiomas are benign tumors that can be treated with various methods, including conservative management and surgical excision. While surgery is considered the optimal treatment for most cases, drug treatment may also be an option in certain situations.

• Propranolol: This beta-blocker has been shown to be effective in treating small hemangiomas, especially those that are capillary-type (ICTHs). According to [12], propranolol can help reduce the size of these tumors and may even cause them to involute. However, treatment typically needs to continue until about 1 to 2 years of age.
• Timolol: This medication is another option for treating small hemangiomas. A gel containing timolol can be applied directly to the affected skin, which may help reduce the size of the tumor [12].
• Conservative management: In some cases, intramuscular hemangiomas may not require treatment at all. These tumors often undergo gradual fatty replacement, atrophy, and involution over time, especially in individuals younger than 30 years [2].

Important Considerations

It's essential to note that drug treatment is typically reserved for small hemangiomas or those that are capillary-type (ICTHs). Larger or deeper tumors may require surgical excision to ensure complete removal and prevent recurrence.

Additionally, the decision to use drug treatment should be made on a case-by-case basis, taking into account factors such as tumor size, location, patient age, and overall health. A thorough evaluation by a qualified healthcare professional is necessary to determine the best course of action for each individual case.

References:

[12] - Timolol gel application may help reduce hemangioma size [2] [12] - Propranolol treatment can cause hemangiomas to involute in children

Differential Diagnosis of Intramuscular Hemangioma

Intramuscular hemangiomas are rare vascular tumors that can be challenging to diagnose due to their similarity in appearance and symptoms with other soft tissue lesions. The differential diagnosis for intramuscular hemangioma includes:

• Lipoma: A benign tumor composed of fat cells, which can mimic the appearance of an intramuscular hemangioma on imaging studies [8].
• Neurofibroma: A type of nerve sheath tumor that can present with pain and swelling in a skeletal muscle, similar to an intramuscular hemangioma [8].
• Pleomorphic adenoma: A benign tumor that can occur in the soft tissues, including muscles, and may be mistaken for an intramuscular hemangioma due to its variable appearance [8].
• Angiosarcoma: A rare and aggressive type of cancer that can arise from blood vessels, which is a critical differential diagnosis for intramuscular hemangioma due to its different treatment and prognosis [11].
• Osteoid osteoma: A benign tumor that occurs in bone, but can sometimes be mistaken for an intramuscular hemangioma on imaging studies, particularly if it involves the surrounding soft tissues [7].

Key Considerations

When considering a differential diagnosis for intramuscular hemangioma, it is essential to take into account the patient's age, sex, and symptoms, as well as the imaging appearance of the lesion. A combination of clinical features, pathological findings, and imaging studies can help differentiate an intramuscular hemangioma from other soft tissue lesions.

References

[8] SK LK (2016) Cited by 21 — Provisional diagnosis of a vascular lesion was made and differential diagnosis of other soft tissue lesions like lipoma, neurofibroma, pleomorphic adenoma ...

[7] YL Yeh (2017) Cited by 9 — Although osteoid osteoma was considered in the differential diagnosis, MRI with enhancement should be performed to exclude intramuscular hemangioma.

[11] DH Kim (2007) Cited by 20 — Intramuscular hemangioma can mimic myofascial pain in the calf, and should be considered in the differential diagnosis if conservative treatment fails.