A case series of primary intraosseous cavernous hemangioma of the skull

Introduction Primary intraosseous cavernous hemangiomas (PICHs) are vascular hamartomas arising within the bone. PICHs are rare bone tumors accounting for 0.7% to 1.0% of all bone tumors, generally seen in adults. Cranial PICHs demonstrate a female predominance. PICHs usually occur in the vertebral column and are rarely seen in the skull. The pathogenesis of PICH is still not known but a history of trauma seems to be related in some case reports. Herein, we present 3 patients with this unusual tumor and discuss the clinical, radiological and pathological features in the light of published data. Case descriptions Our series of three cases includes 2 pediatric patients aged 9 and 12 years and an adult patient aged 22-yrs. They presented with local swellings and CT showed expansion of the bone with ground-glass haziness. The radiological impression was of an eosinophilic granuloma or fibrous dysplasia. The lesions were excised and on gross examination these were circumscribed, slightly globular and dark red to brown in colour. Cut section was firm to hard and haemorrhagic with many small cystic spaces ranging in size from 0.2 to 1 cm. Histopathological examination of the specimen demonstrated intraosseous cavernous hemangioma. Conclusion Primary intraosseous cavernous hemangiomas (PICHs) of the skull are rare, benign vascular lesions that often exhibit radiological features overlapping with those of other calvarial tumors, making preoperative differentiation challenging. Consequently, the diagnosis is frequently suspected intraoperatively, based on their characteristic hemorrhagic nature, and is subsequently confirmed by histopathological examination. Complete surgical excision with tumor-free bony margins remains the treatment of choice, and recurrence is exceedingly rare.