Hemangioma is one of the most common benign neoplasm involved on head and neck. However, cavernous hemangiomas are relatively rare in preauricular sinus space and has rarely been reported around the world. Recently, a 44-year-old female patient came to our clinic with cavernous hemangioma involving the preauricular sinus. This case was surgically managed via excision. Preoperatively, it was difficult to differentiate the mass of hemangioma clinically and diagnostically from a preauricular fistula, a salivary gland tumor, or an enchondroma. This case report describes the subcutaneous hemangioma on a preauricular sinus, which is rarely seen in Korea. The clinical presentation and management are discussed with a review of the literature.
Hemangioma is the commonly found benign neoplasm involved on head and neck.
A 44-year-old female came to our department with a 5-month history of intermittent right preauricular swelling and febrile sensation. She denied having had hearing loss, aural fullness, otaglia, tinnitus, and painful sensation. Her medical, surgical and family history were unremarkable. Upon physical examination, an ovoid shaped mass was softly palpable on 1 cm anterior from the tragus of right ear. The other findings of the head and neck were not significant but particularly, there was no pit around the softly palpable mass. Also, there was no secretion and painful sensation with pressure. Computed tomography (CT) demonstrated a 0.9 cm sized soft tissue mass in anterolateral to the right external auditory canal, which enhanced with contrast. The isolated mass was ovoid shaped and well-marginated without evidence of bony erosion of outer ear (
Under general anaesthesia, the mass was smoothly excised via the preauricular approach. The standard technique for preauricular sinus excision was used with a careful elliptical incision anterior to the crus and tragus on the superior portion of the mass and dissection without epithelial remnants. The size of the surgical specimen was 1.0×0.8 cm, reddish and soft (
Hemangioma is a benign vascular soft tissue tumor that is probably an abnormal development of embryonic vasculature.
Both contrast-enhanced CT and MR imaging are the useful diagnostic tools. Considering this case, MR imaging would be superior to CT because previous reported studies show that MR imaging clearly differentiated cavernous hemangiomas from hypervascular tumors.
According to the vessel type, three histopathological types of hemangioma have been reported.
Treatment options for hemangioma of head and neck area include irradiation, injection of sclerosing agents, embolization, and most effectively, surgical excision.
Hemangiomas are benign vascular tumors that are very rarely seen and reported in a preauricular sinus. From this single case report, the authors emphasize that radiologic findings would be generally insufficient for the correct diagnosis, and careful surgical excision is the treatment of choice.
Preoperative axial computed tomography demonstrates a soft tissue density in the right preauricular sinus. The middle ear cavity and mastoid antrum are clear.
The postoperative surgical specimen shows a red colored, smooth surfaced mass, measuring 1.2×0.6 cm.
Histopathologic findings of the cavernous hemangioma was demonstrated. Low magnification shows well circumscribed, exophytic mass, delineated by squamous epithelium and vascular proliferation (H&E stain, ×40). High magnification shows mature capillary vessels lined by flattened endothelial cells and plump endothlial cell proliferation (H&E stain ×100).