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Case Report | DOI: https://doi.org/10.31579/2690-4861/280
Department of General Surgery, NKP Salve Institute of Medical Science and Research Centre and Lata Mangeshkar Hospital Nagpur Maharashtra, India.
*Corresponding Author: Mohd Yunus Shah, Department of General Surgery, NKP Salve Institute of Medical Science and Research Centre and Lata Mangeshkar Hospital Nagpur Maharashtra.
Citation: Riaz T., Muhammad S. Parwani, Om P. Chilwant, Fulare S., Mohd Y. Shah, (2023), Giant Tongue Hemangioma - A Rare Case Report. International Journal of Clinical Case Reports and Reviews. 13(2); DOI: 10.31579/2690-4861/280
Copyright: © 2023 Mohd Yunus Shah, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 28 November 2022 | Accepted: 19 December 2022 | Published: 10 February 2023
Keywords: tongue hemangioma; AV malformation of tongue; vascular malformation of tongue
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25/f came to surgery opd with complaints of swelling over tongue for 2 years. The swelling was painless and static in nature. Patient had no other complaints.
On examination: swelling of size 4 x 3 cm present over dorsal and lateral aspect of right side of anterior 2/3 rd. part of tongue. Swelling is firm, non-tender, non-mobile with well-defined margins.
USG tongue - a heterogeneous lesion of size2.5 x 2.1 x 1.5 cm present over tongue. Lesion is shows vascularity on color doppler suggestive of hemangioma of tongue MRI oral cavity (plain + contrast) - a well-defined lesion of size 2.7 x 1.9 x 2.5 cm appearing isodose to the muscle and hyperdense in T2W1 and STIR is noted involving the body of tongue on anterior and lateral aspect on right side.
It involves the intrinsic muscles of tongue; it involves ant part of genioglossus and hog loss us on right side This lesion shows homogeneous enhancement on contrast Suggestive of benign neoplastic etiology like hemangioma Surgical treatment
• A nasotracheal intubation was performed.
• The surgical procedure was performed by means of a bipolar cautery with ultrasonic energy which had demonstrated to be a useful
tool in surgical management of vascular malformations.
• Excision of hemangioma with primary repair of the floor of tongue was performed after stabilizing the lesion.
• The specimen was sent for histopathological confirmation.
• Macroscopic: single irregular greyish black, firm to hard in consistency. On cut surface shows white and light brown area.
• Microscopic: section reveals stratified squamous epithelium. Skeletal muscle fibers appear
beneath it. Mature adipose tissue also seen suggestive of intramuscular hemangioma of tongue (A) - marked dilated with congested blood vessels.
(B) - Proliferation of small and large blood vessels with lobules of Capillary sized vascular channels lined by layer of flattened endothelial cells.
• The International Society for the Study of Vascular Anomalies (ISSVA) classification of 2014 divides the vascular anomalies between tumor lesions and vascular malformations. Hemangiomas (infantile, congenital, tufted, spindle-cell and
epithelioid) are benign tumors, unlike vascular malformations (capillary, lymphatic, venous, arteriovenous or combined) [1].
• Hemangioma is the tumor of the blood vessels. Hemangioma may mimic the oral cavity in a number of other lesions. Pyogenic granuloma, chronic inflammatory gingival hyperplasia, epulis granulomatosis, telangiectasia, angiosarcoma, squamous
cell carcinoma, and other vascular appearances, such as Sturge Weber Syndrome [2].
• Clinically, hemangioma is characterized by sessile or pedunculated soft, smooth or lobulated lesion, and can vary in any size from a small lesion as few mm to a large one up to several cm. The color of this lesion can be pink to red purple which
blanches on applying pressure. The hemorrhage can occur either spontaneously or sometimes after minor trauma and is usually painless [4].
• Management of hemangioma include surgery, corticosteroids, radiotherapy, electrocauterization, cryosurgery, laser, embolization, radiofrequency, and interferons. Total excision is difficult and high chances of recurrences are seen.
Corticosteroids should be applied only in selected cases due to systemic side effects. Radiotherapy regresses hemangiomas, but causes severe atrophy of tissue [4].
• Hemangiomas Superficial (capillary hemangioma). Deep (cavernous hemangioma)
Compound (capillary cavernous hemangioma).
• Vascular malformations Simple lesions Low-flow lesions.
▪ Capillary malformation (capillary hemangioma, port-wine stain).
▪ Venous malformation (cavernous hemangioma).
▪ Lymphatic malformation (lymphangioma, cystic hygroma).
• High-flow lesions. - Arterial malformation.
• Combined lesions Arteriovenous malformations Lymph venous malformations [6].
The natural history of the hemangioma is also influenced by the type, site, and age of onset. It typically initiates as a small area of discoloration that progress to a patch with age-dependent proportional growth with increasing grades of morbidity. Treatment goal would be to restore the anatomical continuity and physiological function [5].
Majority of the tongue hemangioma are associated with macroglossia, in our case report the 25/f had a solitary static swelling over tongue without macroglossia. With complete surgical excision and primary closure patient had mobility of tongue and had no problem with production of speech thus making this a rare presentation in all tongue hemangiomas.
• Giant hemangioma of tongue is a rare AV malformation involving the head and neck.
• Surgical removal with primary repair of floor of tongue can be the treatment for giant tongue hemangioma. Nevertheless, surgery on vascular lesions of tongue may be difficult due to massive intraoperative bleeding and airways compromise.
• Surgical outcomes are more predictable than medical outcomes in such case.
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