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Cavernous Hemangioma

Cavernous hemangioma is the most common benign orbital tumor found in adults. The tumor usually rests inside the extraocular muscle cone (that space immediately behind the eye surrounded by the muscles which move the eye).

Cavernous hemangioma is nothing but a type of hemangioma composed of blood-filled "lakes" and channels. It contains stagnant blood.

A cavernous hemangioma may diminish in size following trauma, bleeding or ulceration but it rarely disappears on its own. Small cavernous hemangiomas situated on the surface of the body may be removed or treated by electrocoagulation. Surgery is usually needed if a cavernous hemangioma causes increased growth of an extremity.

Cavernous hemangiomas are not static lesions and are believed to enlarge due to recurrent hemorrhage into the lesion. This results in gradual enlargement of the lesion and resulting symptoms due to mass effect. In one series, the incidence of symptomatic hemorrhage was 1.1% per lesion per year.

General Microscopic Description of Cavernous Hemangioma

  • Histologically, the lesion is characterized by large, thin walled blood vessels completely filled with blood.
  • In contrast to other hemangiomas, vascular channels are of large diameter (hence, cavernous or like a cave).
  • Evidence of previous hemorrhage often seen.

Symptoms of Cavernous Hemangioma

  • Unilateral, painless proptosis.
  • ECHO shows intraconal mass.
  • Vision not usually affected unless mass is pushing on the eye.
  • May cause optic nerve compression leading to visual loss, gaze-evoked amaurosis, or optic nerve swelling.
  • Low flow vascular lesion.
  • CT scan shows well-circumscribed, intraconal, round mass without invasion into adjacent soft tissue and bone.

How is Cavernous Hemangioma diagnosed?

The diagnosis of a cavernous hemangioma is usually straightforward at clinical examination, although indeterminate lesions are usually confirmed with imaging studies. Imaging is also used to assess the extent of the abnormality, as well as possible associated abnormalities.

Cavernous hemangiomas are rarely congenital or familial. Although most of the cavernous hemangiomas are unifocal, congenital or familial forms may display multiplicity and/or multiple system involvement.

How are Cavernous Hemangiomas Treated?

Cavernous hemangiomas that involve the eyelid and obstruct vision are generally treated with injections of steroids or laser treatments that rapidly reduce the size of the lesions, allowing normal vision to develop. Large cavernous hemangiomas or mixed hemangiomas, when appropriate, are treated with oral steroids and injections of steroids directly into the hemangioma.

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Cavernous Hemangioma of Brain and Liver