Large Orbital Pediatric Intraosseous Hemangioma

Area of Science:

• Craniofacial Surgery
• Pediatric Oncology
• Vascular Malformations

Background:

• Intraosseous hemangiomas (IOHs) are uncommon benign vascular tumors, typically affecting adult females and rarely involving the craniofacial region.
• Pediatric craniofacial masses often raise concerns for malignancy, necessitating thorough diagnostic evaluation.
• Orbital and frontozygomatic IOHs are exceptionally rare, presenting unique diagnostic and therapeutic challenges.

Observation:

• A five-year-old male presented with progressive right facial swelling.
• Multiple biopsies were performed before diagnosis.
• Imaging revealed a large, 5.3 cm polyostotic frontal-zygomatic primary intraosseous hemangioma with bony destruction and a soft tissue mass.

Findings:

• The pediatric IOH mimicked a malignant tumor due to its size, rapid progression, and bony destruction.
• The large size and rapid growth presented diagnostic challenges, including obtaining adequate tissue samples.
• Surgical management was complicated by the potential for significant blood loss in a young child.

Implications:

• This case underscores the importance of considering rare vascular malformations in the differential diagnosis of pediatric craniofacial masses.
• The largest reported pediatric IOH highlights the need for specialized surgical planning and multidisciplinary care.
• Further research into the management of large, rapidly progressing pediatric craniofacial IOHs is warranted.