P 370
Primary orbital intraosseous hemangioma
F. Colombo, C. Hofmann-Rummelt, L. M. Holbach
Introduction: Hemangiomas are among the most frequent space-occupying orbital lesions. In contrast, hemangiomas of the bone are rare. They represent less than 1 % of all bony tumors. Few primary orbital intraosseous hemangiomas (POIH) have been reported. They present most frequently in the fourth decade of life.
Patients and methods: We describe the clinical, radiologic and histopathologic findings in a patient with POIH.
Results: A 75-year-old male presented with a slowly progressive, firm, bony mass of the left orbital rim inferolaterally. He had been operated of a nephroma 10 years ago. The periorbital mass did not produce exophthalmus or globe displacement. The rest of the ocular examination was unremarkable. CT scans showed a bony lesion located in the zygoma and protruding towards the orbit, well circumscribed, with internal radiating trabeculations and without signs of destruction of the surrounding tissue. Through a lateral canthotomy and cantholysis, a hard, rounded protuberance, purplish in color, was exposed on the orbital floor. The salient portion of the mass was excised with an oscillating saw, incising the tumor at the level of the adjacent normal bone. Macroscopically, one side of the tumor was covered with periostium, through which cystic spaces filled with blood were visible. The underlying tissue consisted of spongy, spiculated bone with blood cysts. Microscopically, the tumor showed multiple, large, thin-walled vascular spaces filled with blood and surrounded by osseous trabeculae. The diagnosis was POIH of cavernous type.
Conclusion: POIH are rare tumors that may affect elderly patients. A radiologic honeycomb appearance without adjacent tissue destruction is suggestive of an intraosseous hemangioma. Indications for surgical excision in the absence of visual disturbances includes previous history of malignant disease.
Department of Ophthalmology and Eye Hospital, University Erlangen-Nürnberg, Erlangen, D-91054 Erlangen