![]() ![]() Surgical excision was very difficult because of profound bleeding despite the preoperative embolization. Polyvinyl alcohol (PVA) particles were administered through multiple external carotid artery branches to the tumor this procedure resulted in near-total devascularization on postembolization angiography ( Fig 3). Immediately before surgery, preoperative embolization was performed to reduce hypervascularity. To reveal the histopathologic diagnosis of the mass, an incisional biopsy was performed, resulting in the diagnosis of Kaposiform hemangioendothelioma.įollow-up MR images obtained 6 months after initial presentation.Ī, Axial T2-weighted image shows a large heterogeneous expansile mass at the temporal bone.ī, Axial T1-weighted image shows intratumoral multifocal hemorrhages ( arrows) and vascular flow voids that are related to hypervascularity ( arrowheads).Ĭ, Gadolinium-enhanced T1-weighted axial image shows a strongly enhancing tumor, destruction of the petrous bone, and compression of the brain stem and medial temporal lobe.ĭ, Temporal bone CT reveals a large soft-tissue mass with severe bone destruction in left petrous bone.ĭecompressive surgical resection was planned to prevent the tumor from causing neurologic deficits associated with the rapid growth and parenchymal compression. A malignant peripheral nerve sheath tumor or malignant vascular tumor, including aggressive hemangioendothelioma or angiosarcoma, was considered at this time. Findings of neurologic examination, otherwise, were unremarkable. Clinically, left facial palsy still existed and progressive hearing loss had occurred. Multifocal hemorrhages were present within the tumor, and it was strongly enhancing with prominent intratumoral vessels ( Fig 2). It was performed after 6 months and unexpectedly showed a huge bone-destructing tumor at the original site, which compressed the brain stem and left temporal lobe without parenchymal signal-intensity changes but did not cause neurologic symptoms related to the compression. Therefore, only a follow-up MR imaging was planned. The patient was too young to receive any intervention for diagnostic or therapeutic purposes. However, this patient had no stigmata of neurofibromatosis that might be related to the schwannoma on physical, familial, or imaging basis. Radiologic diagnosis for the nodule was facial or acoustic nerve schwannoma or hemangioma. On MR images, a small strong enhancing nodule was seen in the left internal auditory canal ( Fig 1). Temporal bone CT showed a slight enlargement of the left internal auditory canal, but there was no bone erosion or destruction. Cranial imaging was performed to reveal any lesion causative of the facial nerve palsy. Findings of laboratory studies for blood cell count and coagulation were not remarkable. Facial nerve palsy of the peripheral type was suspected. On neurologic examination, facial asymmetry involving the unilateral forehead and cheek was noted, particularly when he was smiling. He was vaccinated as scheduled, did not undergo any surgery, and was not admitted for other diseases. He had no intrauterine disease or perinatal problem. The baby had been born to healthy parents at 40 weeks of gestation by normal delivery. We present clinical and radiologic findings of a rapidly growing Kaposiform hemangioendothelioma in the internal auditory canal.Ī 6-month-old male infant presented with facial asymmetry associated with left facial nerve palsy. 3 To our knowledge, there has been no report of Kaposiform hemangioendothelioma appearing within the cranial vault or in the skull base. 3 Kaposiform hemangioendothelioma is mostly located in the retroperitoneum and skin, but it can occur occasionally in the head and neck regions, mediastinum, and deeper soft tissues of trunk and extremities, whereas other hemangioendotheliomas mostly involve the distal extremities or skin. 2 Concerning the histopathologic classification and biologic behavior of hemangioendothelioma, Kaposiform, retiform, and composite types of hemangioendothelioma are known to be intermediate malignant tumors, and epithelioid hemangioendothelioma, to be a highly malignant tumor. 1 It is often associated with Kasabach-Merritt syndrome, but not always. Kaposiform hemangioendothelioma is a rare vascular tumor found predominantly in infancy and early childhood. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |