PDF | In adults, hemangioma is a rare presentation of a parotid mass. Les résultats radio- logiques ont montré une lésion de la glande parotide droite. Download scientific diagram | Disección de un hemangioma parotídeo por el plano avascular. from publication: Surgical treatment of haemangiomas | The. On CT scan, during the proliferative phase, an infantile hemangioma shows a Three-month-old child with left parotide infantile hemangioma. (a).

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Otolaryngology Head and Neck Surgery Department. D, Oral and Maxillofacial Surgeon. Oral and Maxillofacial Surgery Department. Hemangiomas account for 0.

We report the case of a 62 year padotideo woman with a parotidro in the parotid right tail associated with fluctuating swelling episodes unrelated hemagnioma meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed.

During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation.

In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults. Cavernous hemangioma, parotid gland, superficial parotidectomy, pleomorphic adenoma.

Hemangiomas are vascular abnormalities that are characterized by increased proliferation hemangioam renewal of endothelial cells. They are classified as cavernous, capillary and mixed hemangiomas 1. A 62 years old female with no family history of interest has a right parotid mass with a slowly progressive growth of 4 years of evolution.

Initially, it was asymptomatic and subsequently, fluctuating swelling episodes, not associated with meals, in the parotid region appeared. On physical examination, a soft, elastic, painless, non-fluctuating, non-pulsatile mass without trophic skin changes and of 3x2cm of maximum diameter, was palpated in the tail of the right parotid gland. The parotid duct was permeable with transparent production of saliva. Cervical lymphadenopathy or other masses were not palpable.

The result hemanfioma FNA was inconclusive. In the MRI, at the superficial lobe of the parotid gland, posterolateral to the retromandibular vein, a well-defined mass 3 x 2. It appeared as a lobulated tumor, hyperintense on T2, hypointense on T1, and with intense and homogeneous enhancement after intravenous contrast administration but without extension to adjacent structures Fig. A MRI T1 reveals in the right superficial lobe of the parotid gland a well defined, hipointense and psrotideo intraparotid tumor of approximately 3cm.


It is located posterior and lateral to the retromolar vein. Rest of the glandular parenchyma has normal morphologic features and intensity. B MRI T2, shows the same image but the tumor is hyperintense.

Cavernous hemangioma of the parotid gland in adults

C MRI T1 with contrast, shows the same image but with intense enhancement of the tumor. The provisional diagnosis is a clinical and radiological benign parotid tumor: So it was decided to perform a right superficial parotidectomy.

During surgery, the hhemangioma appearance was of a not encapsulated and hemorrhagic, well-defined tumor that suggests a vascular lesion. The histopathological study reports a tumor with vascular proliferation of different caliber, mostly of them widely dilated and congestive, that showed a lobar pattern distribution.

The vessels are lined by flattened endothelium without atypia and with a thin wall supported parotidek a dense collagen layer. Centrally a hyalinized stroma is identified Fig.

Cavernous hemangioma of the parotid gland in adults

All suggestive of a cavernous hemangioma of the parotid gland. A Microscopic image that reveal a vascular proliferation of different caliber, mostly wide dilated and congestive, that shows a lobular distribution pattern. The vessels are covered with flattened endothelium without atypia and with a thin wall supported by a dense collagen layer. The vascular endothelium of the tumor is enhanced X. At a 6 months of follow-up, the patient was asymptomatic, with a favorable clinical course, and without the presence of tumor recurrence.

If this signs are absent as in this case report, the diagnosis could be challenging, particularly in an adult patient in whom this disease is not suspected as the main possibility 45. There are multiple reports of capillary hemangiomas of the parotid parottideo in pediatric population, which generally tend to involve. Cavernous hemangiomas in adults does not regress, and they tend to have a chronic course and a slowly hemangkoma growth 5. Due to the low prevalence of hemangiomas in adults, with about 50 cases reported worldwide 6.

They are not usually taken into consideration in the differential diagnosis of parotid masses. Therefore, recurrent mumps, tumors or cystic lesion of glandular origin or hypertrophy of the masseter muscle hemangiima the principal differential diagnosis.

In adults, the pleomorphic adenoma and the Hemangloma tumor are within the most common benign tumors of salivary glands 2. Magnetic resonance imaging MRI is useful in demonstrating lesions of the parotid region and its extension. Hemangiomas usua-lly appear as a lobulated lesion with intermediate signal on T1, hyperintense on T2 and homogeneous enhancement with contrast.

MRI also helps determine the surgical approach for the tumor and to reveal the relationship with adjacent structures. The fine needle aspiration FNA is useful in the preoperative diagnosis parotidep tumors of the head and neck. It is considered unnecessary in a hemangioma because of the probability of generating a hematoma and when MRI is highly suggestive of the diagnosis.


Therefore, a typical clinical presentation and characteristic radiologic findings are sufficient for the diagnosis 78. Currently, the treatment of choice in the cavernous intraparotid hemangioma is surgery, taking into consideration a pre-surgical embolization.

However, infantile hemangiomas have other treatment options such as endovascular sclerotherapy, hemangioa or systemic corticosteroids, vincristine, and propanolol 9. Researching studies have found recently, the expression of the cyclo-oxygenase 2 COX2 protein on endothelial cells of various vascular spaces of cavernous hemangiomas.

There is little evidence of the relation of vascular tumors with the expression of COX2. However, there has been reported that high doses of celecoxib have inhibited the cell proliferation of angiosarcomas cell lines. So it could be considered as a hmangioma therapeutic line research for tumors of vascular origin National Center for Biotechnology InformationU. J Clin Exp Dent.

Published online Dec 1. Beatriz Peral-Cagigal 2 M. Beatriz Madrigal-Rubiales oarotideo M. Author information Article notes Copyright and License information Disclaimer. Conflict of interest statement: There are no conflicts of interest by the authors regarding this article. Received Jun 1; Accepted Jun This is an open-access article distributed under the terms of the Creative Commons Attribution License, which hemangima unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Hemangiomas account for 0. Case Report Hemangiomas are vascular abnormalities that are characterized by increased proliferation and renewal of endothelial cells.

Open in a separate window. Cavernous Hemangioma with large phlebolith of the Parotid Gland. Hemangioma of the salivary gland: Parotido R, Donoff B. Intraparotid hemangioma in an adult: Case report and review of the literature. Int J Paotideo Surg.

Case Reports in Pediatrics

Parotid Cavernous Hemangioma in an Adult. Ear Nose Throat J. Pathology and Genetics of Head and Neck Tumours. Kaneko K, Kanai R. Cavernous Hemangioma of the Accesory Parotid Gland. Hemangiomas and vascular malformations of the head and neck: Current Treatment of Parotid Hemangiomas. Adult sporadic parotid hemangioma with COX2 Expression. Support Center Support Center. Please review our privacy policy.