RESUMO

SUMMARY: Hemangiomas are the most common non-cystic benign liver tumors. Typically, they are incidentally discovered through routine radiological imaging. These tumors can become complicated and develop fibrosis, with the extreme presentation being hepatic sclerosing hemangioma (HSH), a very rare, atypical benign tumor. Initial diagnosis of HSH is often erroneous, as it can be confused with primary or secondary malignant liver neoplasms. Consequently, HSH are frequently resected, and the diagnosis is confirmed through histological and immunohistochemical studies of the resected specimen. The aim of this manuscript was to report a surgically treated case of HSH and review the existing evidence regarding its clinical and morphological characteristics. The case of a 79-year-old male patient, who underwent surgical intervention for HSH at RedSalud Mayor Temuco Clinic in October 2023, was examined. A solid tumor situated Segment VI, measuring 4 cm in its largest dimension was identified. MRI demonstrated a mass with low-signal intensity mass on T1-weighted images and areas of high-signal intensity on T2-weighted images and a hypointense mass in the hepatobiliary phase. The tumor was completely excised. Subsequent to histopathological analysis, immunohistochemical staining was performed for WT1, CD31, ERG, CD34, and Pancitoqueratina AE3 & AE1. The patient experienced an uneventful postoperative course and was discharged on the third day after the surgery. During follow-up assessments, the patient's overall condition remains satisfactory. HSH is an exceedingly rare tumor. Clinical features and imaging findings associated with this type of lesion are non-specific. It should be included in the differential diagnosis of solid liver lesions. Complete surgical resection with clear margins is the treatment of choice, and it prognosis is favorable.

Los hemangiomas son los tumores hepáticos no quísticos benignos más comunes. Lo habitual es que se descubran de forma incidental con imágenes radiológicas de rutina. Estos pueden complicarse y desarrollar fibrosis, cuya presentación extrema es el hemangioma esclerosante hepático (HEH); un tumor benigno atípico muy poco frecuente, cuyo diagnóstico inicial suele ser erróneo, confundiéndose con neoplasias malignas primarias o secundarias del hígado. Por ello, es frecuente que sean resecadas y que el diagnóstico se establezca mediante estudios histológicos y de inmunohistoquímica del espécimen resecado. El objetivo de este manuscrito fue reportar un caso de HEH, que fue intervenido quirúrgicamente; y revisar la evidencia existente respecto de sus características morfológicas y clínicas. Caso clínico: Hombre de 79 años, con HEH intervenido quirúrgicamente en Clínica RedSalud Mayor Temuco en octubre de 2023. Se verificó un tumor sólido de 4 cm de diámetro mayor, localizado en el segmento VI del hígado. La resonancia magnética demostró una masa con baja intensidad de señal en T1 y áreas de alta intensidad de señal en T2. El tumor fue extirpado por completo. Después del estudio histopatológico, se realizaron tinciones inmunohistoquímicas complementarias para WT1, CD31, ERG, CD34 y Pancitoqueratina AE3 & AE1. El paciente tuvo un curso postoperatorio sin incidentes, siendo dado de alta al tercer día postoperatorio. En el control alejado, se encuentra en buenas condiciones generales. El HEH es un tumor muy poco frecuente. Las características clínicas e imágenes de este tipo de lesiones son inespecíficas. Debe de las lesiones sólidas del hígado. La resección considerarse en el diagnóstico diferencial quirúrgica completa con bordes libres es el tratamiento de elección; y su pronóstico es favorable.

Assuntos

RESUMO

ABSTRACT Vascular anomalies comprise a wide spectrum of clinical manifestations related to disturbances in the blood or lymph vessels. They correspond to mainly tumors (especially hemangiomas), characterized by high mitotic activity and proliferation of the vascular endothelium, and malformations, endowed with normal mitotic activity and no hypercellularity or changes in the rate of cell turnover. However, the classifications of these lesions go beyond this dichotomy and consist various systems adapted for and by different clinical subgroups. Thus, the classifications have not reached a consensus and have historically caused confusion regarding the nomenclatures and definitions. Cavernous venous malformations of the orbit, previously called cavernous hemangiomas, are the most common benign vascular orbital lesions in adults. Herein, we have compiled and discussed the various evidences, including clinical, radiological, morphological, and molecular evidence that indicate the non-neoplastic nature of these lesions.

RESUMO

Introducción: El hemangioma cavernoso es una de las neoplasias benignas más frecuentes en la infancia. Objetivo: Describir el caso de un hemangioma cavernoso en edad pediátrica. Caso clínico: Lactante femenina de 6 meses de edad, de procedencia urbana, cuyo nacimiento tuvo lugar en el Hospital Materno Fe del Valle Ramos, del municipio Manzanillo. Al nacer se observa una lesión en forma placa eritematosa violácea infiltrada de ± 10 cm, de borde definido, de superficie liza, con aumento de temperatura al tacto, que se extendía desde la parte medial anterior y posterior hasta la superior de la pierna del miembro inferior izquierdo. Se decidió interconsultar con el Servicio de Angiología, el cual diagnostica la lesión como hemangioma cavernoso. Conclusiones: Se corroboró que el hemangioma cavernoso es una entidad frecuente en la infancia, su diagnóstico y tratamiento oportunos son altamente beneficiosos para la mejoría y la cura, por lo que se impone la realización de un correcto y exhaustivo examen físico, de lo que se deriva también la prevención de complicaciones a corto, mediano y largo plazo(AU)

Introduction: Cavernous hemangioma is one of the most frequent benign neoplasms in childhood. Objective: To describe the case of a cavernous hemangioma at pediatric age. Clinical case: A 6-month-old female infant of urban origin was born at Hospital Materno Fe del Valle Ramos, Manzanillo Municipality, Granma Province. At birth, a violaceous erythematous plaque-like infiltrated lesion was observed, of approximately 10 cm, with a defined border, smooth surface, increased temperature at hand contact, extending from the anterior and posterior medial part to the upper leg of the left lower limb. It was decided to do an interconsultation with the angiology service, which diagnosed the lesion as a cavernous hemangioma. Conclusions: Cavernous hemangioma was corroborated to be a frequent entity in childhood, whose timely diagnosis and treatment are highly beneficial for improvement and cure, so it extremely necessary to carry out a correct and exhaustive physical examination, also deriving the prevention of complications in the short, medium and long terms(AU)

Assuntos

RESUMO

Diffuse cavernous hemangioma (DCH) is a rare benign vascular lesion. The rectosigmoid colon is the most common site of this disease. It affects mainly young adults. The most frequent symptom is chronic rectal bleeding which is painless, often begins in the infancy and sometimes is uncontrollable. Endoscopy is the diagnose method of choice and complete surgical excision with sphincter-saving procedure is the primary mode of treatment. A high index of suspicion and a correct diagnose is necessary. We present a 34-year-old male with a DCH of the rectum and anus who required an APR because of affection of dentate line.

El hemangioma cavernoso difuso (HCD) es un tumor vascular benigno raro. Su localización más habitual es el rectosigma. Se presenta en adultos jóvenes como rectorragia indolora y recurrente, que suele aparecer en la infancia y puede llegar a ser incontrolable. La endoscopia digestiva es el método diagnostico de elección. El único tratamiento eficaz consiste en la resección completa siendo deseable la realización de una técnica con conservación esfinteriana. Un alto índice de sospecha y un correcto diagnóstico son necesarios. Presentamos el caso de un varón de 34 años con un HCD del anorecto que requirió una resección abdominoperineal.

Assuntos

RESUMO

BACKGROUND: Cavernous hemangiomas, more accurately defined as cavernous venous malformations, constitute the most common primary intraorbital tumors of adults comprising 4-9% of all tumors,[4] and the second most frequent cause of unilateral proptosis after thyroid-related orbitopathy.[3] Over 80% are located within the intraconal compartment, most commonly in the lateral aspect.[1] Surgical treatment for orbital cavernous hemangioma is generally required in symptomatic cases, optic nerve compression, and cosmetically disfiguring proptosis.[2] Transcranial approaches, the most familiar approaches for neurosurgeons, provide wide access to the entire superior and lateral orbit. They usually offer direct visualization, allowing for a safer dissection, while minimizing significant injury to the native neural and vascular anatomy of the orbit.[5] Although transcranial approaches continue to evolve, in many cases, they have been supplanted by endoscopic skull base approaches and modifications to deep lateral orbitotomy approaches.[5]. CASE DESCRIPTION: A 62-year-old male patient presented with slowly expanding left proptosis, which he had first noticed 3 years before presentation. He was already blind in his right eye due to a history of traumatic amaurosis in childhood. The left eye examination revealed severe proptosis with restricted eye movement in all directions and significant visual impairment (visual acuity of 20/300, expressed by Snellen test, with no improvement on correction). MRI of the orbit showed a large left superolateral intraconal cavernous hemangioma compressing and displacing the optic nerve, with the typical feature of slow gradual irregular enhancement with delayed washout on contrast-enhanced image. A one-piece modified orbitozygomatic approach was performed and a total en block resection was achieved. The bone flap was fixed with titanium miniplates and screws, the temporal muscle and the skin were closed in a standard fashion. The patient did not present any new deficit in the postoperative period. The patient had good functional and cosmetic outcomes with resolution of proptosis, restoration of eye movements, and improvement of visual acuity in the 3-month follow-up. Postoperative MRI showed total resection. CONCLUSION: The orbitozygomatic approach for large orbital cavernous hemangioma provides satisfactory orbital decompression and large working space, reduces traction, and increases visualization and freedom to dissect small vessels and nerves that may be tightly attached to the tumor pseudocapsule.

RESUMO

BACKGROUND: Cavernous hemangiomas are congenital hamartomatous lesions that originate from mesodermal tissue composed of dilated blood vessels. Abdominal pain and palpable mass are the most common presenting symptoms. The different types of treatment for symptomatic patients remain controversial. However, surgical resection is always the most preferred method when possible. To date, there are no reports of endoscopic ultrasound-guided (EUS-guided) absolute ethanol injection as a treatment for such disease when surgery is not an option. CASE PRESENTATION: A 19-year-old girl with giant cavernous intra-abdominal hemangioma extending to the hepatic hilum, also affecting the gastric wall and occupying the entire supra-mesocolic cavity, initially presents with upper gastrointestinal bleeding and loss of 20 kg in 1 year (BMI = 18 kg/m2). Percutaneous angiography identified a mass with arterial blood supply by the left gastric artery that was embolized. After re-bleeding, an alternative treatment with EUS-guided injection of alcohol was proposed once resection was not feasible without major risks to a young patient. This procedure was repeated 15 and 45 days after the initial treatment, with the ethanol injection of 25 cc and 15 cc, respectively. On the second and third procedure dates, there was evident regression of the hemangioma. On the third procedure, it was possible to identify all anatomic structures that were not clear on the first EUS. After 45 days of last injection, abdominal CT and EUS showed notorious regression of the lesion. Eight months later, abdominal CT showed only a remnant lesion in the hepatogastric ligament with 129 cm3 on volumetry (87% lower in comparison to the initial image), and the patient remains asymptomatic with BMI of 26. In the most recent follow-up CT, 4 years and 2 months after first treatment, the patient presents with a slight increase in the hemangioma-now with 183 cm3 on volumetry. CONCLUSION: Transgastric EUS-guided ethanol injection in the treatment of giant intra-abdominal cavernous hemangioma can provide good outcomes without major complications and can be repeated if necessary.

Assuntos

RESUMO

BACKGROUND: The sternum is considered an unusual tumor site, corresponding to 15% of all thoracic wall tumors. Primary sternal tumors are even rarer and most commonly malignant. We present the case of a young man who consulted with a painful sternal mass, which after its resection is confirmed to be a cavernous hemangioma. CASE PRESENTATION: A 39-year-old man, with unremarkable medical history besides a 2-year-long sternal pain, non-irradiated, which worsens over the last few months and is accompanied by the appearance of a sternal palpable mass. On physical exam, there was a bulging of the sternal manubrium, with no inflammatory changes. Thoracic CT scan shows an expansive and lytic lesion of the sternum, compromising the manubrium and extending to the third sternocostal joint, without intrathoracic compromise nor cleavage plane with mediastinal vascular structures. The patient is taken to resection of the mass and sternal reconstruction using prosthetic material and pectoral and fasciocutaneous muscular flaps. Histopathological findings: cavernous hemangioma with negative borders and no other malignant findings. CONCLUSIONS: Sternal hemangiomas can cause defects in the bone structure and show an expansive growth, challenging the differentiation between a benign or malignant lesion. Therefore, they should be considered malignant until shown otherwise. Management involves radical surgery with curative purposes and posterior reconstruction to improve quality of life, as shown with our patient.

Assuntos

RESUMO

INTRODUCTION: Hepatic hemangioma (HH) is the most common benign neoplasm affecting the liver. Most cases are asymptomatic and incidentally found at imaging studies. Giant hepatic hemangiomas are uncommon, but pedunculated giant hemangiomas are even rarer, making their clinical and imaging diagnosis a challenge for the surgeon. PRESENTATION OF CASE: Herein; we report the case of a 26-year-old male patient, who presented to the emergency ward with acute abdominal pain associated with a palpable mass, mimicking a complicated appendicular plastron, additionaly were found it liver enzymes elevated. Then the patient was taken the operating room. An exophytic pedunculated liver tumor that projected towards the right iliac fossa was identified. It had undergone torsion on its pedicle. Transfixing hemostatic sutures were placed, proceeding with its exeresis. The patient tolerated the procedure and was discharged without complications on the third postoperative day. Pathological anatomy confirmed the diagnosis. DISCUSSION: Giant pedunculated HH is an infrequent entity that generates mass effect on intra-abdominal organs causing pain depending on its location. In our case, HH size was 13 cm with elevated liver enzymes, only previously reported in one case of a 20-cm hemangioma. Surgery is indicated for cases of giant and symptomatic lesions. CONCLUSION: Torsioned pedinculated giant liver hemangioma may be part of the differential diagnosis of a patient with acute appendicitis with elevated liver enzymes. The elevation of liver enzymes may be related to the size of the HH.

RESUMO

The aim of this article is show the neuroimaging, the pathological analysis and makes a brief review regarding to a giant cavernous haemangioma located in cavernous sinus in a 72 years old patient. A brief review was made in the literature searching for the key words "hemangioma" and "cavernous sinus" in the databases PubMed and Scielo for the last ten years. The images addressed were obtained by magnetic resonance imaging (MRI) in FLAIR, T1 and T1-weighted contrast-enhanced. The intracranial cavernous haemangiomas are rare conditions that comprise from 0,1 to 4% of intracranial vascular malformations. Diagnosis is made by MRI, when available SPECT (99mTc) is used to confirm and the treatment is done surgically with complement of radiotherapy and radiosurgery. The reported neuroimaging and pathological analysis show a giant cavernous hemangioma in cavernous sinus, a benign neoplasm involving the left internal carotid artery and maintaining contact with the contralateral internal carotid artery formed by abundant vascular structures, but without the presence of a muscular tunic.

RESUMO

PURPOSE: To describe a case report of Cavernous Hemangioma of the Retina (CHR) and highlight the importance of investigating intracranial system when retinal vascular alterations are present. OBSERVATIONS: Patient of 26 years old, with right eye fundus alteration since 7 years old, no visual complaint. In the exam, there were sacular lesions with hematic content in the macula, configurating liquid level, associated with whitish lesion suggestive of fibrosis, compatible with cavernous hemangioma; best visual accuity of 20/20 both eyes. Comparing the current retinography with the previous one, there was no significant lesion progression of the exam. By neuroimaging investigation, the Magnetic Ressonance Imaging showed multiple cavernomas. As his sister had been diagnosed with cerebral cavernous malformation 3 years before, due to termic hiposensitivity on left leg investigation, familial multiple cavernous malformation syndrome was defined. CONCLUSION: Imaging investigation of the Central Nervous System should be considered when CHR is observed. Clinical monitoring is necessary, interventional treatment is selected only for particular cases.

RESUMO

Extradural lumbar spinal canal cavernous hemangiomas (or cavernomas) are rare lesions that can induce intense back pain and neurological deficit. We present a case report of a patient with a pure radicular lombar extradural cavernoma resembling a benign neurological tumor in imaging exams and a successful surgical resection.

Os hemangiomas cavernosos do canal vertebral lombar extradural (ou cavernomas) são lesões raras que podem induzir dor intensa no dorso e déficit neurológico. Apresentamos um relato de caso de um paciente com um cavernoma extradural lombar radicular puro assemelhando-se a um tumor neurológico benigno em exames de imagem e uma ressecção cirúrgica bem-sucedida.

Assuntos

RESUMO

RESUMEN Los hemangiomas son uno de los tumores más frecuentes en cabeza y cuello. Los hemangiomas de laringe se pueden dividir clínicamente en formas infantiles y adultas. En niños es una patología frecuente, mientras que en adultos es muy infrecuente. En adultos, tiene mayor incidencia en hombres y su ubicación más frecuente es supraglótica. Su histología más frecuente es el hemangioma cavernoso (HC), que corresponde a una malformación de origen venoso, con paredes delgadas y vasos dilatados. La presentación más habitual es con disfonía o ronquera de meses o años de evolución y se sospecha mediante la nasofaringolaringoscopía o el estudio de imágenes (TC y/o RM). Existen distintas formas de tratamiento, incluidas la observación, la corticoterapia, la radioterapia, la cirugía láser, la cirugía abierta, etc., sin existir un consenso sobre la mejor opción. Se presenta el caso de un paciente de 43 años con antecedentes de tabaquismo que consultó por una historia de disfonía de un año de evolución. Se diagnosticó mediante nasofaringolaringoscopía y TC de cuello una gran masa supraglótica que se extirpó mediante un abordaje de laringofisura. La biopsia diferida informó un HC.

ABSTRACT Hemangiomas are one of the most frequent head and neck tumors. Clinically, they can be divided into childish and adult forms. In children it is a frequent pathology, whereas in adults it is very rare. In adults, it has a higher incidence in men and its more frequent location is supraglottic. Its most frequent histology is the cavernous hemangioma, which corresponds to a malformation of venous origin, with thin walls and dilated vessels. The most common presentation is with the disphony or hoarseness lasting from months to years of evolution and suspicion is made through nasofibroscopy or the imaging study (CT and / or MRI). There are different forms of treatment, including observation, corticotherapy, radiotherapy, laser surgery, open surgery, etc., without a consensus on the best option. We present the case of a 43 year old male with a history of smoking who consulted for dysphonia of a year of evolution. A large supraglottic mass was diagnosed through nasofibroscopy and CT of the neck, which is removed by a laryngopharyngeal approach. Deferred biopsy reported a cavernous hemangioma.

Assuntos

RESUMO

Pineal cavernous angioma is a vascular malformation that has a prevalence lower than 1%. The etiology is debated. It is believed that it is originated from an autosomal dominant inheritance or from radiotherapeutic treatment. Complete resection enables the cure and prevents complications of the natural evolution of the lesion, mainly hemorrhagic events. A female patient, with 67 years of age, presented mental confusion and visual acuity deficit, which evolved to periods of psychomotor agitation. A magnetic resonance imaging (MRI) scan of the head showed a lobulated mass lesion in the pineal region with hypersignal on T1 and hyposignal on the susceptibility weighted imaging (SWI) sequence. Hydrocephalus was also noticed. The patient underwent a microsurgery for complete lesion resection though a supracerebellar/ supratentorial access. The anatomopathology revealed an arteriovenous malformation compatible with cavernous angioma. The pineal cavernous angioma is a rare malformation that should be considered in the differential diagnosis of expansive lesions of the pineal gland.

Assuntos

RESUMO

Resumen Se realizó un estudio descriptivo tipo reporte de caso de un paciente valorado por el servicio de gastroenterología en la Clínica Nuestra en la ciudad de Cali, por sospecha de sangrado digestivo oculto cuyos estudios previos no habían mostrado causa de sangrado. Se realizó videocápsula endoscópica (MiroCam®) con un hallazgo positivo de lesión en el intestino delgado. Se llevó a enteroscopia en Clínica Farallones de la Ciudad de Cali con enteroscopio Olympus 180 Q que confirmó el hallazgo. Ulteriormente, se llevó a cirugía, en la que se confirmó el diagnóstico. Los datos y las fotografías se obtuvieron en bases de datos de los servicios de endoscopia y las fotos de patología se obtuvieron del registro del médico patólogo. Finalmente, se realizó una búsqueda en PubMed sobre literatura existente de historia clínica y reportes de casos similares.

Abstract This is a descriptive study based on the case report of a patient suspected of occult gastrointestinal bleeding who was evaluated by the gastroenterology service in Clínica Nuestra in Cali. Previous studies had not shown cause of bleeding. Video endoscopy (Mirocam) found a lesion in the small intestine. Enteroscopy at performed at Clínica Farallones in Cali with an Olympus 180 Q enteroscope confirmed the finding. Surgery further confirmed the diagnosis. Data and photographs were obtained from the database of endoscopy services and the pathology photos were obtained from the pathologist's registry. A literature review based on a Pubmed search of the existing literature on clinical histories and reports of similar cases is included.

Assuntos

RESUMO

El hemangioma mediastinal es un tumor vascular benigno poco frecuente que representa el 0,5 % de los tumores mediastinales. Se describe el caso de un paciente de 65 años con un tumor de mediastino anterior correspondiente a un hemangioma cavernoso.

The mediastinal hemangioma is a rare benign vascular tumor representing 0.5 % of mediastinal tumors. We describe a case of a 65 year old patient with an anterior tumor of mediastinum corresponding to a cavernous hemangioma.

Assuntos

RESUMO

La cavernomatosis cerebral (CC), única o múltiple, es la presencia de conductos vasculares distendidos, angiográficamente ocultos, por lo cual clásicamente eran hallazgos incidentales intraoperatorios o en autopsias. Actualmente la resonancia magnética (RM) cerebral, permite identificar éstas lesiones en un mayor número de pacientes. Las manifestaciones clínicas son hemorragias intracerebrales, crisis epilépticas y cefalea. Se reporta el caso de un varón de 55 años, sin antecedentes de importancia que ingresó por presentar cefalea y crisis de arresto del habla. El examen físico fue normal. Estudios tomográficos previos mostraron una lesión hemorrágica única, al realizarse una RM cerebral con protocolo T2-eco gradiente se evidencia múltiples imágenes compatibles con CC múltiple. Es el primer reporte de CC múltiple, entidad poco diagnosticada, que se debe sospechar en pacientes sin antecedentes de riesgo vascular que debutan con hemorragias intracerebrales, crisis epilépticas y/o cefaleas; constituyendo la RM cerebral en protocolo T2-eco gradiente, el estudio indicado para el diagnóstico.

Cerebral cavernomatosis (CC), single or multiple, is the presence of distended vascular channels, angiographically occult, for that, they are classically incidental intraoperative findings at autopsy. Currently the magnetic resonance imaging (MRI) let us identify these lesions in a larger number of patients. Clinical manifestations are intracerebral hemorrhages, seizures and headache. A male, 55, no history of significance is reported; he was admitted for headache and some months later presents speech arrest crisis. On physical examination, nothing unusual. Previous tomographic studies showed a hemorrhagic lesion, when the brain MRI with T2-eco gradient protocol was performed, multiple images observed, were compatible with multiple CC. This is the first report of multiple CC, unfrequent entity that should be suspected in patients with no history of vascular risk who present intracerebral hemorrhage, seizure and / or headache; being the brain MRI, the study indicated for diagnosis.

RESUMO

Se informa un caso de hemangioma cavernoso del mesosigmoide, su presentación clínica, diagnóstico y tratamiento, y se ofrece una revisión de la literatura asequible sobre el tema, para lo cual se realizó una búsqueda en las bases de datos de Medigraphic, Cochrane, Medline y PubMed. El paciente es un hombre de 72 años de edad, que se presentó con dolor abdominal, estreñimiento, pérdida de peso y masa tumoral en la fosa ilíaca izquierda. A pesar de las investigaciones imaginológicas y endoscópica, no se pudo hacer el diagnóstico preoperatorio. Se trató por laparotomía y resección del tumor, y el diagnóstico se confirmó por estudio histopatológico. El hemangioma cavernoso del mesosigmoide es un tumor raro, difícil de diagnosticar preoperatoriamente, a pesar de las avanzadas técnicas imaginológicas. La escisión quirúrgica y el examen histológico pueden ser los únicos medios para el diagnóstico.

This article reported a case of cavernous hemangioma of the mesosigmoid, its clinical presentation, diagnosis and treatment. It also offered literature review on this topic for which search into the Medigraphic, Cochrane, Medline and Pubmed databases was made. The patient was a 72 years-old man that went to the hospital with abdominal pain, constipation, loss of weight and tumor mass in the left iliac cavity. Despite imaging and endoscopic research, it was not possible to reach diagnosis preoperatively. He underwent laparotomy and tumor resection and the final diagnosis was confirmed in the histopathological study. The cavernous hemangioma of the mesosigmoid is a rare tumor difficult to preoperatively diagnose despite the advanced imaging techniques. Surgical excision and histological exam are the only means to reach diagnosis.

Assuntos

RESUMO

Colorectal cavernous hemangioma is a rare benign vascular neoplasia that may be found in any segment of the colon and cause recurrent and painless rectal bleeding. Standard treatment of rectal hemangioma consists of resection of the affected segment followed by coloanal anastomosis. Massive bleeding during the operation is the most feared complication, especially during extensive resection or reoperation. The authors describe a preoperative embolization of a rectal hemangioma with Onyx-18(R) and microspheres, in a 49-year-old patient with successful prevention of uncontrolled hemorrhage during surgery. (AU)

O hemangioma colorretal cavernoso é uma neoplasia vascular benigna rara, que pode comprometer qualquer segmento do colón e causar sangramento retal indolor recorrente. O tratamento habitual da doença retal inclui ressecção do segmento afetado seguido de anastomose coloanal. Sangramento retal no intra-operatório é uma complicação temível especialmente durante ressecções extensas ou reoperações. Os autores descrevem a embolização pré-operatória com microesferas e Onyx-18(R) de um hemangioma retal em um paciente de 49 anos, com controle satisfatório de hemorragia maciça durante o ato cirúrgico. (AU)

Assuntos

RESUMO

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and it's by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome.

Os hemangiomas cavernosos são os tumores intraorbitais mais comuns encontrados em adultos de meia-idade. Embora histológico benigno, eles podem invadir a área orbital ou intraorbital ou ainda as estruturas adjacentes (nervo óptico) e ser considerado anatomicamente ou posicional maligno. Apresentamos um relato de caso de hemangioma cavernoso orbital da órbita direita em mulheres jovens após a gravidez, a partir de Topola perto Kragujevac (Central Sérvia), com comprometimento visual e medicado por tratamento cirúrgico endoscópico transnasal. O paciente foi controlado e tratado com terapia, terapia tópica sintomático de lágrimas artificiais e tratamento cirúrgico. Nosso paciente tem acuidade visual ideal do olho direito afetada após o tratamento cirúrgico de tumor orbital. O tratamento cirúrgico do sintomático hemangioma cavernoso orbital é segura e eficaz, de modo que os resultados cosméticos são o parâmetro importante para avaliar o resultado clínico.

Assuntos

RESUMO

O hemangioma cavernoso é uma neoformação vascular benigna de origem congênita, caracterizando pela formação de grandes canais e espaços vasculares preenchidos com sangue. O caso relatado no estudo chama atenção não só devido à magnitude da tumoração e ao comprometimento vascular, mas também pelo tempo de permanência da lesão, desde os 10 anos de idade. O tratamento para essa lesão varia com o tamanho, risco de ruptura do hemangioma e com a sintomatologia do paciente. As condutas que podem ser utilizadas são: ressecção cirúrgica; embolização arterial; enucleação cirúrgica e radioterapia. A raridade e complexidade do caso, somados à dificuldade de tratamento encontrada pela paciente no decorrer desses 20 anos de evolução tumoral, foram fatores que corroboraram para a apresentação desse caso.

The cavernous hemangioma is a benign vascular neoformation of congenital origin, characterizing by the formation of large vascular spaces filled with blood. The case reported in this study differentiates itself from other cases of hemangiomas, not only because of the magnitude of the tumor and the vascular compromise, but also due to the time of permanence that this tumor was lodged since she was 10. The treatment for this type of injury varies with the size and risk of a rupture of the hemangioma, and with the symptoms of the patient. Surgical resection, artery embolization, surgical enucleation and radiotherapy can be chosen by the doctor as alternatives for the treatment. The rarity and complexity of this case, added to the difficulty of treatment found by the patient during those 20 years of tumor development, compose the factors that corroborated to the presentation of this case.

Assuntos