Bone Haemangioma Of The Hyoid Bone

Dr. Ghulam Saqulain

Head of Department of ENT

Capital Hospital, Islamabad

A Case Report:

Abstract & Key Words Abstract

Occurrence of bone Haemangioma in association with long bones, short tubular bones and ribs is extremely rare. In this article, we report a case of hyoid bone Haemangioma. The present case is the first reported case of bone Haemangioma arising from the hyoid bone without bleeding tendency. A literature search did not reveal any precedence in world literature for such a Haemangioma arising from the hyoid bone.

Key Words:

Hyoid boneHaemangiomaPrimary bone neoplasm

Introduction Haemangioma are benign vascular lesions with 4 histological

variants: cavernous, capillary, Arterio-venous and venous.

Bone Haemangioma constitute less than 1% of all primary bone neoplasms.

They are predominantly of the cavernous and capillary varieties. They occur most frequently in the vertebral column & Skull, followed

by facio-maxillary skeleton. Involvement of long bones, short tubular bones and ribs is extremely rare. There is no reported case of bone hemangioma arising from the hyoid bone.

Accurate diagnosis and surgical excision is the key to management.

Prognosis is good with recurrence rare.

Case Report

A Thirty year old male presented, to the ENT Department at Capital Hospital, Islamabad, with a swelling in right submandibular region of five months duration with no other symptom.

Examination showed a 8 cm x 5 cm, ovoid, non pulsatile mass in submandibular region extending to the retromandibular area.

The swelling lacked signs of inflammation. It was firm in consistency with well defined rounded margins and moving with the movement of the hyoid bone.

Cranial nerve examination did not reveal any involvement.

No other positive finding Ear Nose and throat examination.

Routine investigations were all normal save for a opaque shadow in sub-mandibular area observed on plain films.

Fine needle aspiration for cytology failed due to non yielding nature of the swelling.

Incision biopsy also failed due to the fact that we did not take a deep biopsy due to the hard nature of the swelling.

CP WBC 7.2 10^3/uL

NE% 52.2 Ly% 34.4 MO% 8.7 EO% 4.7

Hb 15.7 g/dl PLT 348 10^3/uL

ESR 05mm/1st hr. Blood Group A +ve. HCV Ab Negative HBsAg Negative LFT’s

ALAT 37 U/l Alk. Phos 106 U/l Total Bilirubin 0.8 mg/dl

RFT’S Urea 31 mg/dl Creatinine 0.7 mg/dl

RBG 84 mg/dl

CT Scan14.6.2004, Iran

There is an ill-defined and heterogenous enhancing mass in rt. Parapharyngeal space extending caudally to the anterior aspect of the neck with erosion and expansion of the hyoid bone.

Possibility of salivary gland masses is suggested. Possibility of hyoid bone originating primary or secondary masses could be in the DDX. Biopsy on the guide to sonography would be helpful.

MRI12.12.2005 NIHd

MRI neck shows a well defined, iso-intense, moderately enhancing mass lesion occupying the right sub mandibular and retro mandibular region,pressing on adjacent structures, It measured 3.2 x 2.2 cms. The mass isslightly indenting the nasopharynx on the right side. The mass showed heterogeneous signal on T2W1 sequence. The mass was slightly indenting the nasopharynx on right side.

CT Scan

Having taken advice from an pathologist, an excision biopsy was planned.

Keeping in view the immobile nature of the mass, after due preparation including arrangment for blood transfusion patient was operated on under General Anaesthesia with endotracheal intubation.

The mass was approached through a wide submandibular incision 2-3 cm below the mandibular margin.

On exposure a hard ovoid mass with well defined rounded margins was encountered arising from the hyoid bone and involving the greater cornu.

The muscular attachments were removed from the swelling, as if it were a giant greater cornu of the hyoid.

The mass had to be pulled out from the deep sub-mandibular and retro-mandibular area.

There was no extension into soft tissue of neck.

The mass was removed in toto including part of hyoid bone.

There was fortunately no significant bleeding.

Gross Examination

Gross examination of the specimen revealed a bony mass measuring 4.5 x3 x 1.5 cms.

After decalcification the mass was cut into two.

Its cut surface was bony in appearance and showed dark brown and grayish white areas..

Part bearing muscle attachment

Part separate from healthy hyoid bone.

Histology Bone Haemangioma

Histology revealed proliferation of thin walled blood vessels lined by a single layer of endothelial cells interspersed by trabeculae of mature bone. The lamina of blood vessels were filled with RBCs. The marrow showed fibrosis. There was no evidence of malignancy. The features are compatible with Hemangioma, Hyoid Bone.

Post Operative Treatment

Antibiotic Analgesics Stitches Removed after a week