Surgical Excision as the First Therapeutic Choice in Single-muscle Hemangiomas: a Case Series

Document Type : RESEARCH PAPER


Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran


Background: Conservative management is generally the primary treatment for intramuscular hemangimas. However,
many patients will require surgery later in their life, after suffering a long period of pain. We aimed to evaluate the
oncologic and functional outcomes of surgery as the initial treatment of single-muscle hemangiomas.
Methods: Medical profiles of 17 patients with hemangiomas of vastus medialis for whom surgery was selected as
the initial treatment were reviewed. The indication for surgery was a bothersome pain. Postoperative muscle strength
was assessed with manual muscle testing (range 0-5). The postoperative pain was measured by a visual analog scale
(VAS) for pain (range 0-10). Lyshölm-Tegner knee scoring scale was used for the evaluation of knee function.
Results: The mean age of the patients was 25.9±8.6 years. Surgery was performed as wide resection in 13 cases and
as marginal resection in 4 cases. At a mean follow-up of 55.76±30 months, two local recurrences (11.8%) were observed.
At the last evaluation session, muscle strength grade was 5/5 in 13 patients and 4/5 in four patients. Postoperative
pain was noticed in four patients (VAS=1). Knee function was excellent in 13 patients and good in four patients. Both
of the local recurrences occurred in marginally resected lesions. Three out of four cases with reduced muscle strength,
postoperative pain, and reduced function were also treated with marginal resection.
Conclusion: If a wide surgical margin is achievable without compromising the limb function, surgical resection could
be considered as the primary choice of treatment for single-muscle hemangiomas.
Level of evidence: IV


1. Enzinger F. Benign tumors and tumorlike lesions of
blood vessels. Soft tissue tumors. St. Louis: Mosby;
2. Wojcicki P, Wojcicka K. Epidemiology, diagnostics and
treatment of vascular tumours and malformations.
Adv Clin Exp Med. 2014; 23(3):475-84.
3. Sami SH, Jamshidi K, Shoushtarizadeh T.
Intraarticular synovial cavernous hemangioma:
a case report and review of the literature. Shafa
Orthop J. 2014; 1(2):26-8.
4. Marchuk DA. Pathogenesis of hemangioma. J Clin
Invest. 2001; 107(6):665-6.
5. Wierzbicki JM, Henderson JH, Scarborough MT,
Bush CH, Reith JD, Clugston JR. Intramuscular
hemangiomas. Sports Health. 2013; 5(5):448-54.
6. Bella GP, Manivel JC, Thompson RC Jr, Clohisy DR,
Cheng EY. Intramuscular hemangioma: recurrence
risk related to surgical margins. Clin Orthop Relat
Res. 2007; 459(1):186-91.
7. Tang P, Hornicek FJ, Gebhardt MC, Cates J, Mankin
HJ. Surgical treatment of hemangiomas of soft tissue.
Clin Orthop Relat Res. 2002; 399(1):205-10.
8. Cohen AJ, Youkey JR, Clagett GP, Huggins M, Nadalo
L, d’Avis JC. Intramuscular hemangioma. JAMA. 1983;
9. Allen P, Enzinger F. Hemangioma of skeletal muscle.
An analysis of 89 cases. Cancer. 1972; 29(1):8-22.
10. Beham A, Fletcher C. Intramuscular angioma:
a clinicopathological analysis of 74 cases.
Histopathology. 1991; 18(1):53-9.
11. Jamshidi K, Jafari D, Shirazi MR, Pahlevansabagh
A, Shoushtaryzadeh T. An unusual presentation of
ossified intramuscular hemangioma: a case report.
Acta Med Iran. 2014; 52(4):319-22.
12. Fergusson I. Haemangiomata of skeletal muscle. Br J
Surg. 1972; 59(8):634-7.
13. Jamshidi K, Karimi A, Bagherifard A, Mirzaei A.
Aneurysmal bone cysts of the clavicle: a comparison
of extended curettage and segmental resection with
bone reconstruction. J Shoulder Elbow Surg. 2019;
14. Jamshidi K, Mirkazemi M, Izanloo A, Mirzaei A.
Locking plate and fibular strut-graft augmentation
in the reconstruction of unicameral bone cyst of
proximal femur in the paediatric population. Int
Orthopaedics. 2018; 42(1):169-74.
15. Jamshidi K, Bagherifard A, Mirzaei A, Bahrabadi M.
Giant cell tumor of the sacrum: series of 19 patients
and review of the literature. Arch Bone Jt Surg. 2017;
16. Mendell JR, Florence J. Manual muscle testing. Muscle
Nerve. 1990; 13(S1):S16-20.
17. Hawker GA, Mian S, Kendzerska T, French M.
Measures of adult pain: visual analog scale for pain
(Vas Pain), numeric rating scale for pain (NRS Pain),
mcgill pain questionnaire (MPQ), short‐form mcgill
pain questionnaire (SF‐MPQ), chronic pain grade
scale (CPGS), short form‐36 bodily pain scale (SF‐36
BPS), and measure of intermittent and constant
osteoarthritis pain (ICOAP). Arthritis Care Res.
2011; 63(Suppl 11):S240-52.
18. Negahban H, Mostafaee N, Sohani SM, Mazaheri M,
Goharpey S, Salavati M, et al. Reliability and validity
of the Tegner and Marx activity rating scales in
Iranian patients with anterior cruciate ligament
injury. Disabil Rehabil. 2011; 33(22-23):2305-10.
19. Brozzetti S, Polistena A, De Angelis M, Bononi M, Miccini
M, Mazzoni G, et al. Treatment of giant intramuscular
hemangioma: a multistep approach in three patients.
Anticancer Res. 2005; 25(3C):2417-21.
20. Wu JL, Wu CC, Wang SJ, Chen YJ, Huang GS, Wu SS.
Imaging strategies in intramuscular haemangiomas: an
analysis of 20 cases. Int Orthop. 2007; 31(4):569-75.
Volume 8, Issue 3
May 2020
Pages 439-444
  • Receive Date: 26 May 2019
  • Revise Date: 22 August 2019
  • Accept Date: 24 August 2019
  • First Publish Date: 01 May 2020