Roentgen Characteristics of Cavernous Hemangioma of Striated Muscle

In december 1957, it was stated by Bendeck and Lichtenberg (2) that approximately 400 cases of cavernous hemangioma of striated muscle had appeared in the literature. In reviewing the series thus far reported, it is evident that great difficulty has been experienced in making a correct preoperative diagnosis of this condition. Undoubtedly, failure to think of hemangioma as a possibility is the major factor responsible, but it is also clear that the findings on the plain roentgenogram are not commonly appreciated. While the reported series show a preoperative diagnostic accuracy of up to a maximum of 46.5 per cent (8), roentgen changes were present in from 48 to 73 per cent. Certainly, if these changes had suggested the possibility of hemangioma, the diagnosis would have been made with much greater frequency. It is evident that correct preoperative recognition of the lesion is of great importance, since an unexpected encounter with the large vascular channels feeding and draining one of these tumors may present a formidable problem, particularly to those unfamiliar with this type of surgery. The classification of tumors of blood and lymph vessels is a complicated problem and one upon which agreement is not universal. Hemangiomas may be divided broadly into capillary and cavernous types. The former are seen microscopically as a mass of newly forming capillaries with a sparse fibrous stroma, while the cavernous lesions appear as large blood-filled spaces lined by flat endothelium. Subforms of the cavernous type comprise almost all of the hemangiomas of special organs, such as the liver, intestine, bone, and muscle. Of 93 cases reported by Johnson et al. (8), 73 were discrete and 20 diffuse. These tumors are usually felt to be entirely benign, but Pack (11) states that malignant transformation may occur in rare instances. Matas (10) and others have reported cases of“benign metastasizing hemangiomata" but Stout (15) feels that these were actually hemangioendotheliomas from the beginning, rather than hemangiomas. The etiology of hemangiomas is obscure. They have most commonly been considered congenital abnormalities, but the work of Andervont (1), who has produced hemangiomas with carcinogens, throws doubt on congenital factors as the sole causal mechanism. The majority of the tumors are present at birth but may remain asymptomatic until late childhood or early adult life. Most of those which produce symptoms, however, do so before the age of thirty. They seem to be somewhat more common among females. Hemangiomas of skeletal muscles have a predilection for sites distal to the elbow and below the knee. The most common symptoms, in order of frequency, are the presence of a mass, pain, swelling, and cosmetic change. The mass may alternately increase and decrease in size, pain often being noted with enlargement. The reason why these tumors produce pain is not well understood.