J Korean Ophthalmol Soc.  2014 Jul;55(7):1084-1088.

A Case of Intramuscular Muller Muscle Hemangioma of Upper Eyelid Mimicking Sarcoidosis

• Kim HC
• Ahn HJ
• Lew H

Abstract

PURPOSE
We report a case of Muller muscle intramuscular hemangioma in the upper eyelid mimicking dacryoadenitis.
CASE SUMMARY
A 21-year-old male patient presented with a 2-year history of upper eyelid swelling in his right eye and no symptom relief with oral corticosteroid. Increased angiotensin-converting enzyme (ACE) was noted in the laboratory findings. However, lid inflammation was not improved and the patient underwent incisional biopsy.
CONCLUSIONS
Microscopically, the lesion was composed of proliferating vessels of various sizes between the individual smooth muscle fibers. Intramuscular hemangioma rarely presenting as a benign tumor in the head and neck region can present as diffuse swelling mimicking sarcoidosis or dacryoadenitis.

Keyword

Eyelid; Intramuscular hemangioma; Muller muscle

MeSH Terms

Biopsy
Dacryocystitis
Eyelids*
Head
Hemangioma*
Humans
Inflammation
Male
Muscle, Smooth
Neck
Sarcoidosis*
Young Adult

Figure

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  Figure 1. (A, B) Facial photographs show diffuse erythematous swelling in the right upper eyelid, and the enlarged lacrimal gland (arrow) was noted. (C) A congestive and inflamative lacrimal gland (arrow) was noted in physical examinations with upper eyelid eversion 2 weeks later. (D) He had recovery and no evidence of recurrence during the follow up period of 3 months.

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  Figure 2. (A, B) Orbital CT scan with enhancement images show a mild enlargement and infiltration of right lacrimal gland. A tiny suspected hyperintensity lesion was noted at the right upper eyelid (arrow).

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  Figure 3. Microscopic findings of intramuscular hemangioma. (A, B) Proliferation of small to medium sized blood vessels between the bundles of smooth muscle (H&E, × 100 (A), × 200 (B)). (C, D) Immunohistochemical stain for smooth muscle (smooth muscle actin stain) was positive (S.M.Actin, × 100 (C), × 200 (D)).

Reference

References

1. Rossiter JL, Hendrix RA, Tom LW, Potsic WP. Intramuscular hemangioma of the head and neck. Otolaryngol Head Neck Surg. 1993; 108:18–26.

2. Lopez-Cedrun JL, Urtasun Fernandez J, Melendez Baltanas J, Lopez Garcia JA. Hemangioma of the temporalis muscle: a case report and review of the literature. J Oral Maxillofac Surg. 1996; 54:1130–2.

3. Allen PW, Enzinger FM. Hemangioma of skeletal muscle. An analysis of 89 cases. Cancer. 1972; 29:8–22.

4. Wolf GT, Daniel F, Krause CJ, Kaufman RS. Intramuscular hemangioma of the head and neck. Laryngoscope. 1985; 95:210–3.

5. Weiss SW, Folpe AL. Enzinger and Weiss's Soft Tissue Tumors. 4th ed.St. Louis: Mosby;2001. p. 869–72.

6. Skoulakis CE, Maistrou D, Drivas EI, et al. Intramuscular haemangioma of the orbicularis oculi muscle of the orbit. Acta Otorhinolaryngol Ital. 2007; 27:263–5.

7. Lee HC, Lee SJ, Kim YD. Intramuscular hemangioma of the upper lid. J Korean Ophthalmol Soc. 2003; 44:2428–33.

8. Liston R. Case of erectile tumour in the popliteal space. Removal. Med Chir Trans. 1843; 26:120–32.

9. Kiratli H, Bilgiç S, Caglar M, Söylemezoglu F. Intramuscular hemangiomas of extraocular muscles. Ophthalmology. 2003; 110:564–8.

10. Christensen SR, Borgesen SE, Heegaard S, Prause JU. Orbital intramuscular haemangioma. Acta Ophthalmol Scand. 2002; 80:336–9.

11. Rhew JY, Jun RM. A case of intramuscular hemangiomas of upper eyelids. J Korean Ophthalmol Soc. 2012; 53:1680–4.

12. Giudice M, Piazza C, Bolzoni A, Peretti G. Head and neck intramuscular haemangioma: report of two cases with unusual localization. Eur Arch Otorhinolaryngol. 2003; 260:498–501.

13. Clemis JD, Briggs DR, Changus GW. Intramuscular hemangioma in the head and neck. Can J Otolaryngol. 1975; 4:339–46.

14. Stofman GM, Reiter D, Feldman MD. Invasive intramuscular hemangiomas of the head and neck. Ear Nose Throat J. 1989; 68:612–6.

15. Chen MT, Yeong EK, Horng SY. Intralesional corticosteroid therapy in proliferating head and neck hemangiomas: a review of 155 cases. J Pediatr Surg. 2000; 35:420–3.

16. Itinteang T, Brasch HD, Tan ST, Day DJ. Expression of components of the rennin-angiotensin system in proliferating infantile haemangioma may account for the propranolol-induced accelerated involution. J Plast Reconstr Aesthet Surg. 2011; 64:759–65.