Unusual Presentation of a Capillary Haemangioma: Case Report

Abstract

Introduction: Capillary haemangiomas are benign endothelial cell neoplasms and are the most common tumours of the orbit and  periorbital area in childhood[1,2]. They are believed to be due to harmatomatous proliferation of vascular endothelial cells[2]. They  may present as small isolated lesions of minimal clinical significance, large disfiguring masses that may cause visual impairment,  and/or systemic complications or could be part of a clinical syndrome[1,3] . Thirty percent present in the first few weeks of life. The tumour usually undergoes an initial rapid growth phase over the first 3-6 months, then a phase of stabilization after the age of 1 year,  and then the phase of spontaneous regression (30-50% by 3years and 60-75% by 4-7 years)[1]. We report an unusual presentation of  capillary haemangioma in an adult.

Case Presentation: A 36 year old man who presented four years ago with a two year history of a right eye swelling. It progressively  increased in size; it was first noticed in the medial aspect of the upper and lower lid with eventual superotemporal dystopia. There  was no history of change in size with Valsalva maneuver nor swelling in the other eye or any other part of his body. There was progressive visual deterioration. There was redness, tearing, discharge, and excessive itching. However, there was no eye pain, head  ache, dizziness, seizures or loss of consciousness. There was no history suggestive of any form of bleeding disorder, wheezing,  breathlessness, easy fatigability, fainting attacks. Thirteen years prior to presentation, he had a similar swelling of about three years  duration in the same eye and underwent a surgical excision in a private facility in Kaduna, with a histological diagnosis of a Capillary  Haemangioma. There is a positive family history of similar lid swelling in patient’s father, paternal uncle and grandmother with  spontaneous regression. However details of the onset and other characteristics of these swellings in the family members could not be  obtained. General examination revealed essentially normal findings. He had a visual acuity of “Counting Fingers” at 1 meter and 6/5 on  the right and left respectively. There was a 34cm non axial proptosis in the right eye with supero-temporal displacement of the globe. Superiorly, there was a mass measuring about 2x2cm; and inferiorly there was a 6x2x1cm mass (Figure 1). They were both  cystic, non-tender and mobile with normal overlying skin. The conjunctiva was chemosed, and cornea was hazy due to stromal oedema. Further view was precluded. The left eye appeared normal. A clinical diagnosis of Recurrent Orbital Capillary Haemangioma  was made. Differentials diagnoses entertained include: orbital carvenous venous haemangioma, orbital venous varix, pleomorphic adenoma.