Rare Case of an Intramuscular Hemangioma of the Foot: A Case Report With a Review of the Literature

Abstract

Hemangiomas are benign tumors characterized by an abnormal proliferation of blood vessels, which can be particularly challenging to diagnose and manage when located in unusual sites such as the foot. Herein, we report a case of a 36-year-old woman with a plantar hemangioma on the right foot, characterized by a long-standing, periodically changing subcutaneous lump. Clinical examination and magnetic resonance imaging revealed a hyperintense mass involving the musculus flexor digitorum brevis. The patient underwent surgical excision, which was complicated by intraoperative rupture of the mass but ultimately resulted in complete removal. Histopathological analysis confirmed the diagnosis of an intramuscular hemangioma. Postoperative recovery was uneventful, and follow-up showed no recurrence after six months. This case highlights the critical role of accurate diagnosis through physical examination and imaging, particularly magnetic resonance imaging, to differentiate benign hemangiomas from malignant tumors and guide treatment. While surgical excision is the primary treatment for symptomatic or cosmetically concerning hemangiomas, less invasive alternatives like sclerotherapy may be appropriate for superficial lesions. Effective management requires precise diagnostic imaging and a tailored therapeutic approach.

Keywords: diagnostics; foot; histopathology (hp); intramuscular hemangioma; treatment.

Figure 1. Preoperative photograph illustrating the tumorous mass on the plantar surface of the patient's right foot.

Figure 2. MRI illustrating a hyperintense mass in front of the bodies of the third and fourth metatarsal bones, involving the musculus flexor digitorum brevis. (a) View in the sagittal plane; (b) view in the transverse plane; (c) view in the frontal plane.

Figure 3. Intraoperative photograph depicting the extirpation of the tumor. The tip of the tweezers indicates the location where the tumor mass ruptured, resulting in the drainage of dark blood.

Figure 4. Histopathological photograph showcasing the typical features of a cavernous intramuscular hemangioma at (a) magnification ×10 and (b) magnification ×40. The black circle indicates muscle tissue; the arrowhead points to a fibrous septum outlined with endothelium; and the asterisks (*) indicate the cavernous space filled with blood.

Figure 5. Postoperative photographs taken 14 days after surgery (a) and at the six-month follow-up (b).