AJR 2002; 179:790
© American Roentgen Ray Society
Radiologic—Pathologic Conference of Keller Army Community Hospital at West Point, the United States Military Academy: Bilateral Temporal Fossa Hemangiomas
Liem T. Bui-Mansfield1,2,3,
Cris P. Myers4,
Douglas Fellows1 and
Glen Mesaros5
1 Department of Radiology, Keller Army Community Hospital, 900 Washington Rd.,
West Point, NY 10996-1197.
2 Department of Radiology, Uniformed Services University of Health Sciences 4301
Jones Bridge Rd., Bethesda, MD 20814-4799.
3 Department of Radiology, Wake Forest University School of Medicine, Medical
Center Blvd., Winston-Salem, NC 27157-1088.
4 Department of Pathology, Walter Reed Army Medical Center, 6900 Georgia Ave.,
Washington, DC 20307-5001.
5 Department of Surgery, Keller Army Community Hospital, West Point, NY
10996-1197.
Received February 8, 2002;
accepted after revision March 4, 2002.
The opinions and assertions contained herein are those of the authors and
should not be construed as official or as representing the opinions of the
Department of the Army or the Department of Defense.
Address correspondence to L. T. Bui-Mansfield.
Introduction
A 44-year-old man presented with a right temporal fossa mass. Preoperative
CT revealed heterogeneously enhancing, well-circumscribed, soft-tissue masses
in both temporal fossae. On T1-weighted MR images, the masses were isointense
relative to muscle. On T2-weighted MR images, the masses had predominantly
heterogeneous high signal intensity with foci of low signal intensity
(Fig. 1A). After gadolinium
administration, patchy enhancement was present
(Fig. 1B). The patient
underwent excision of both masses (Fig.
1C). Histologic evaluation of these masses was consistent with
cavernous hemangiomas (Fig.
1D).
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Fig. 1A. —Bilateral temporal fossa hemangiomas in 44-year-old man.
Axial T2-weighted MR image shows well-circumscribed high-signal masses with
central low-signal-intensity dots (arrowheads) in both temporal
fossae.
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Fig. 1B. —Bilateral temporal fossa hemangiomas in 44-year-old man.
Coronal T1-weighted MR image with fat suppression and gadolinium
administration shows patchy enhancement of masses (arrowheads).
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Fig. 1D. —Bilateral temporal fossa hemangiomas in 44-year-old man.
Photomicrograph of pathology specimen shows well-circumscribed proliferation
of large, thin-walled, dilated blood-filled vessels arranged in diffuse
haphazard pattern. Walls of these vessels consist predominantly of dense
fibrous connective tissue lined by flattened endothelium. (H and
E,x4)
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Soft-tissue masses of the temporal fossa are rare. Differential diagnoses
include epidermoid cyst, soft-tissue sarcoma, metastasis, myositis ossificans,
temporal arteritis, arteriovenous malformations, and temporal muscle
herniation through a defect of the anterior temporalis fascia.
Hemangioma is one of the most common soft-tissue tumors, constituting 7% of
all benign tumors. Hemangioma is a benign vascular lesion that may contain
nonvascular elements such as fat, fibrous and myxoid tissue, smooth muscle,
thrombus, and even bone. Hemangiomas are classified histologically by the
predominant type of vascular channel (capillary, cavernous, arteriovenous, or
venous) [1]. Fourteen percent
of hemangiomas are found in the head and neck, occurring in the masseter,
trapezius, and sternocleidomastoid muscles. Hemangioma of the temporal fossa
is rare, usually involving the temporal muscle
[2].
On radiography, hemangiomas appear as non-specific soft-tissue masses.
Phleboliths are seen in 30% of the hemangiomas, most frequently in cavernous
hemangiomas [1]. CT reveals a
soft-tissue mass with associated fat overgrowth and serpentine vascular
components, which may enhance after administration of contrast material.
Sonography shows a complex mass with high-vessel density (> five vessels
per square centimeter) and a peak arterial Doppler shift exceeding 2 kHz
(sensitivity, 84%; specificity, 98%)
[3]. MR imaging is considered
the best modality for evaluating hemangiomas. Characteristic MR imaging
features include lobulation, septation, central low-signal-intensity dots, and
marked enhancement after gadolinium administration
[4]. The
septate—lobulated appearance of hemangiomas revealed on T2-weighted
images correlates with fibrous and fatty septa (low signal intensity) between
endothelial-lined vascular channels (high signal intensity). The central
lowsignal-intensity dot sign seen on T2-weighted imaging may represent
fibrofatty septa seen in cross section, hyalinized or thrombosed vascular
channels, smooth muscle components, fast flow in blood vessels, calcification,
or ossification.
Many forms of therapy have been used to control or cure hemangiomas:
steroids, radiation, sclerosing agents, interferon alfa-2a, pentoxifylline,
and surgical excision.
References
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Introduction
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