Masson's Hemangioma of Proximal Radial Artery

Abstract

Tumour like vascular lesions are rare. Here we report a rare case of tumor like vascular lesion from the radial artery. A pulsatile swelling in the forearm is usually diagnosed as a case of Aneurysm, AV fistula or highly vascular tumor. A middle aged man came to us with a painless pulsatile swelling on the lateral aspect of proximal right forearm. The ultrasound scan reported it as case of vascular tumour. Angiogram showed abnormal vascular channels, connected to the aneurysmal dialation of the proximal radial artery. Histopthological examination confirmed it as Masson’s hemangioma after excision. This is a benign condition and complete excision is curative.

Pulsatile swellings in the extremities are usually seen secondary to trauma with development of a pseudoaneurysm with or without arterial venous fistula, and sometimes they are associated with congenital arteriovenous fistulas. Rarely such lesions are diagnosed as angiosarcoma, Kaposi’s sarcoma, cavernous or capillary hemangioma and Masson’s hemangioma [1]. Here, a rare case of Masson’s hemangioma in the right forearm connected with the radial artery is reported.

A middle-aged man presented with a pulsatile swelling in the upper lateral part of the right forearm (see Fig. 1). It was painless and growing slowly. There was increased skin pigmentation in the distal forearm due to application of irritants as folk therapy. The brachial pulse at elbow, radial and ulnar pulses at the wrist are normally palpable. There were no signs of injury or history of fractures in the past. He was a non-smoker, without diabetes and hypertension. Based on the above findings, a radial artery aneurysm was suspected. The ultrasound examination suspected a vascular tumor with abnormal vascular channels connected with the radial artery. Spiral CT angiogram showed (see Fig. 2) abnormal vascular channels with filling defects in continuity with the radial artery. During surgery, it was found that the swelling was few centimeters distal to the bifurcation of the brachial artery. The radial artery was in continuity with the mass and it felt like a thrombosed aneurysm. The excised aneurysmal like mass was sent for histopathological examination. It was reported to be primary Masson’s hemangioma.

Fig. 1.

Clinical photograph showing swelling in the upper and lateral part of forearm

Fig. 2.

Spiral CT angiogram showing intravascular lesion (abnormally dilated vascular channels with filling defects) in continuity with radial artery

In 1923, Pierre Masson described it in an ulcerated hemorrhoidal vein [2]. It is a rare disorder and locally benign tumor, almost always intravascular and clearly distinct from intravascular thrombus. Intracranial, thyroid, neck, breast mass, tongue, external jugular vein, oral cavity were other the sites where this type of lesions were noted. Numerous small papillary structures and complex vascular spaces lined by a single layer of attenuated endothelial cells are the characteristic features under microscope [3].