Cavernous hemangioma of the parotid gland in adults

Abstract

Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland and most of them occur in children, nevertheless in adults hemangiomas are very rare. We report the case of a 62 year old woman with a mass in the parotid right tail associated with fluctuating swelling episodes unrelated to meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed. During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. The classic clinical presentation of a parotid hemangioma is an intraglandular mass associated or not with skin lesions characterized by reddish macules and/or papules, and a vibration or pulsation when palpating the parotid region. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation. In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults. Key words:Cavernous hemangioma, parotid gland, superficial parotidectomy, pleomorphic adenoma.

Figure 1

A) MRI T1 reveals in the right superficial lobe of the parotid gland a well defined, hipointense and lobulated intraparotid tumor of approximately 3cm. It is located posterior and lateral to the retromolar vein. Rest of the glandular parenchyma has normal morphologic features and intensity. B) MRI T2, shows the same image but the tumor is hyperintense. C) MRI T1 with contrast, shows the same image but with intense enhancement of the tumor.

Figure 2

A) Microscopic image that reveal a vascular proliferation of different caliber, mostly wide dilated and congestive, that shows a lobular distribution pattern. The vessels are covered with flattened endothelium without atypia and with a thin wall supported by a dense collagen layer. In the periphery of the proliferation, parotid gland parenchyma is shown with predominance of serous acini and chronic inflammatory infiltration (H&E 45X). B) Microscopic image with immunohistochemical technique, which is CD34+. The vascular endothelium of the tumor is enhanced (100X). C) Microscopic image that shows in greater detail the vascular proliferation (H&E 100X).