A rare case of complex orbital lymphangiohemangioma

Abstract

Background: Complex orbital lymphangiohemangioma is a rare benign vascular lesions. It usually appears as an enlarging mass without specific clinical features and frequently misdiagnosed. This case report highlighted a case of orbital vascular anomalies which presented as intramuscular hemangioma with lymphangioma.
Results: A 12 years old boy with underlying bronchial asthma, presented with painless progressive enlarging swelling over right medial canthal area and right upper lid since age of 6 years old. His best corrected vision was OD 20/50 , OS 20/20. Right eye showed non tender mass at medial canthal area with no skin changes. Anterior chamber and posterior chamber bilateral eye was unremarkable. CT scan showed soft tissue swelling at the medial part of the right orbit involving the medial part of upper and lower eyelid and medial canthal region, measures approximately 2.1cm x 2.4cm x 3.9cm with blocked nasolacrimal duct suggestive of mucocele. Excision biopsy was performed, the intraoperative findings revealed a mass mixed with fibrosis tissue and microcyst with no definite plane with underlying skin and orbicularis oculi muscle. Histopathology examination showed benign vascular lesion likely intramuscular angioma. 3 weeks post operatively, he developed wound breakdown and exploration under GA was done, which intraoperatively showed multiple small slow oozing from remnant of the lesion with multiple cyst surrounding wall of cavity , bluish lesion and small telangiectatic vessels were seen at the upper lid.
Conclusion: Complex orbital lymphangiohemangioma is a rare benign vascular lesion. The recurrence rate is high even after wide surgical excision due to its microscopically infiltrative pattern of diffusion into the surrounding muscular tissue. Long term clinical and radiological follow up are strongly recommended in order to precisely diagnose and treat further recurrences.
Conflicts of interest: The authors report no conflicts of interest.