MRI Features And Treatment Of Pharyngeal Haemangioma

摘要

Pharyngeal haemangioma is a comparatively a rare tumor of the head and neck region . The treatment modalities include surgical removal , sclerotherapy and laser therapy . We report a case of large pharyngeal haemangioma extending from the hypopharynx to the oropharynx. A 60- year old male presented with progressive dysphagia of 1- year duration . A large pharyngeal haemangioma was diagnosed on laryngoscopy and magnetic resonance imaging . Sclerotherapy using 5% mono ethanolamine oleate decreased the tumor volume immediately , without showing any tendency to re grow during last 18 months of follow up . Introduction Haemangiomas are generally considered to be developmental malformations or hamartomas rather than true neoplasm . In the year 1904 , Albrechet defined hamartomas as a tumor like malformation composed of tissue indigenous to the part, but lacking the growth potential of the neoplasm . Haemangiomatous lesions may arise in the skin or anywhere in the mucosa of the upper aero-digestive tract ( 1 ).The most likely vasoformative tumor to be submitted for biopsy from the oral or pharyngeal region is the haemangioma ( 2 ). Most true Haemangiomas require no intervention , but 10 – 20 % requires treatment because of their size , location , behavior , degree of functional compromise or complications . The treatment options include conservative management by monitoring , steroids , cryotherapy , laser therapy , sclerotherapy , and surgical excision ( 3 , 4 ). Case Report A 60- year old male presented with the complaint of progressive dysphagia for last one year , which was more for solid food than for liquids . There was no history of haematemesis , dyspnoea , haemoptysis , or hoarseness of voice . Indirect laryngoscopy revealed a purple coloured pharyngeal mass , “4 × 2 cm” in size , arising from right lateral wall . Laboratory investigations were normal . Direct laryngoscopic examination confirmed a broad based purplish lobulated mass , about “5 × 2 cm” in size with intact overlying mucosa , arising from the right lateral wall of the hypopharynx . It was extending superiorly into oropharynx Prominent vessels and scattered areas of haemorrhage were seen over its surface . A wedge biopsy was taken from the mass , which confirmed the diagnosis of haemangioma . There were no pheleboliths within the tumor . M R I revealed a well defined lobulated hyper intense mass lesion about “5 x 2 cm” arising from right lateral wall of hypopharynx with a broad base , extending cranially into oropharynx “( fig 1 )”. In T1-WI the lesion was iso-intense to muscles ( fig 2 )”. Post-Gadolium images “( fig 3 & 4 )” show heterogeneous and significant enhancement . The patient was subjected to sclerotherapy using 5% mono ethanolamine oleate under general anaesthesia . The tumor decreased in volume immediately after sclerotherapy . The patient is on regular follow-up since last 18 - months , and has not shown any tendency to increase its volume .