Clin Exp Otorhinolaryngol.  2015 Sep;8(3):298-301. 10.3342/ceo.2015.8.3.298.

Intramuscular Hemangioma in the Anterior Scalene Muscle Diagnosed by Core Needle Biopsy

• Cho JK
• Cha W
• Sung MW

• KMID: 2117528
• DOI: http://doi.org/10.3342/ceo.2015.8.3.298

Abstract

Intramuscular hemangioma (IMH) is a rare, benign vascular lesion that frequently develops within skeletal muscles. Preoperatively, accurate diagnosis of IMH is often extremely difficult because of nonspecific clinical findings and the inaccuracy of fine-needle aspiration cytology. IMH is suspected in only 8% of preoperative diagnoses before surgical exploration. Here, we report a case of a 44-year-old man with a huge IMH in the anterior scalene muscle that was preoperatively diagnosed using ultrasonography-guided core needle biopsy, and was successfully treated based on preoperative clinical information.

Keyword

Muscle, Skeletal; Hemangioma; Biopsy, Large-Core Needle; Angiography; Neck

MeSH Terms

Adult
Angiography
Biopsy, Fine-Needle
Biopsy, Large-Core Needle*
Diagnosis
Hemangioma*
Humans
Muscle, Skeletal
Neck

Figure

• 

  Fig. 1 Neck computed tomography (CT) revealed a hypervascular mass, approximately 8.5 cm in size, at the right posterior cervical space (A). On CT, the right carotid artery was anteriorly displaced, and the mass showed isosignal intensity relative to muscle. Magnetic resonance imaging (MRI) was diagnostic and revealed a well-defined mass with slightly increased signal intensity on gadolinium-enhanced T1-weighted fat-saturated imaging (B) and slight increased signal intensity on T2-weighted imaging (C) within the right anterior scalene muscle.

• 

  Fig. 2 Ultrasonography (US) showed a hypoechogenic and hypervascular mass involving the right parapharyngeal space posterolateral to the right common carotid artery. US-guided core needle biopsy was performed without complications.

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  Fig. 3 The core needle biopsy specimen revealed skeletal muscle fragments with increased vasculature and adipose tissue that was diagnosed as intramuscular hemangioma (H&E: A, ×100; B, ×200).

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  Fig. 4 Angiography and tumor embolization were planned 3 days before the elective operation. Angiography demonstrated a hypervascular mass fed by a branch of the right thyrocervical artery, and the mass was successfully embolized. (A) Anterior to posterior view, (B) lateral view.

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  Fig. 5 (A) The specimen revealed increased vascularity among the muscle fibers. The histopathologic diagnosis was consistent with intramuscular hemangioma (H&E: B, ×100; C, ×200).

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