Intraosseous Hemangioma of Sella: Case Report and Review of Literature

Abstract

Background: Primary intraosseous hemangioma (PIH) of the skull base, when localized in the sella, is a rare, benign lesion that can mimic other common sellar tumors. Such tumors may be asymptomatic incidental radiologic findings or present with nonspecific symptoms (e.g., headaches).

Case description: :We present a case of a primary intraosseous hemangioma of the body of sphenoid bone extending into the sellar cavity, clinicoradiographically mimicking an atypical pituitary adenoma.

Conclusions: PIH should be included as a rare differential diagnosis in cases of space-occupying sellar lesions with atypical features. Radiologic and intraoperative findings may be suited to entertain a probable diagnosis; however, a definite diagnosis can only be obtained via histopathologic analysis. Surgical excision may be chosen under the assumption of dealing with a primary pituitary lesion, but extent of resection depends on the accessibility, extent, involvement of surrounding structures (such as the internal carotid artery/cavernous sinus), and control of intraoperative bleeding. When facing inoperable or residual lesions, radiotherapy can be a viable option.

Keywords: ICA, Internal carotid artery; MRI, Magnetic resonance imaging; Mixed hemangioma; PIH, Primary intraosseous hemangioma; Pituitary; Primary intraosseous hemangioma; Sella turcica; Skull base; Sphenoid.

Figure 1

Coronal noncontrast T1-weighted sequence and sagittal T1-weighted sequence following contrast showing a lesion involving the body of sphenoid extending into the sellar cavity that enhances brightly with contrast.

Figure 2

Histopathologic image: intertrabecular fibrotic marrow showing both thin-walled capillary-sized vessels along with few ectatic and thick-walled larger-caliber vessels.