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Case Report

Haemangioma of tongue: A rare case report

Sachin Khanduri, Deepak Agrawal, Garima Varshney, Nidhi Singh
Department of Radio Diagnosis, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India

A B S T R A C T

Vascular anomalies include a wide range of tumors and malformations. Among vascular anomalies, hemangioma is the most common.
Hemangioma is considered as hamartomatous lesion, and half of these have predilection for head and neck region, but rarely seen in the
oral cavity. Here, we report a case of hemangioma in the posterior third of the tongue in a 10-year-old female, which appeared localized
well defined, reddish pink and lobulated mass with well-defined margins on intra-oral examination. A well-defined homogeneously
hyperechoic space occupying lesion (measuring = 4.4 cm × 4.2 cm) seen on ultrasonography which showed abnormally increased
vascularity on color Doppler suggesting a vascular etiology. Further evaluation was done on contrast enhanced computed tomography
scan and magnetic resonance imaging, which confirms its vascular nature and diagnosed as a case of hemangioma.

Key words: Doppler, hemangioma, tongue, ultrasonography, vascularity

INTRODUCTION was present since 1½ years back, it was small at first

Hemangioma (Greek: Haima-blood; angeion-vessel, oma-
tumor) is defined as a tumor of dilated blood vessels.
They are most common vascular tumors of infancy and
childhood.[1,2] Hemangioma are of two types-capillary
and cavernous. They appear in the 1st month of life and
are characterized by rapid proliferative phase and slow
involution, to near spontaneous resolution. Nearly 60-70%
of the lesions are found in head and neck.[3]
Hemangiomas can also be described according to the
vessel involved or flow type like arterial or arteriovenous
type (high flow) or capillary or venous type (slow flow).[4]
CASE REPORT
A 10-year-old girl visited our hospital for a localized
swelling on the posterior third of the tongue. The swelling
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DOI:
10.4103/2321-3841.151645
but gradually increased in size. Patient had difficulty in
swallowing and breathing due to the swelling no history
of pain, fever, and bleeding was present. On general
examination, the built of the patient was normal for age,
and all the vitals were normal. No relevant medical, dental
and family history was present.
Intra-oral examination revealed a localized well defined,
reddish pink and lobulated mass with well-defined margins
in the posterior third of the tongue extending up to the
right tonsilo-lingular sulcus measuring approximately
(5 cm × 6 cm) [Figure 1]. The surface was smooth with
fine granularity. On palpation, it was soft to firm in
consistency nonmobile, afebrile, nontender with no thrill
and blanched on application of pressure. Routine blood,
urine and thyroid profile were normal. On X-ray lateral
view skull showed increased soft tissue shadow in the
oropharynx. On high resolution ultrasonography of tongue
through submandibular approach revealed a well-defined
homogeneously hyperechoic space occupying lesion (SOL)
(measuring = 4.4 cm × 4.2 cm) in the posterior third of
tongue, the SOL showed abnormally increased vascularity
on color Doppler suggesting a vascular etiology [Figure 2].
On computed tomography (CT) scan of neck, a well-
defined moderate sized homogenously iso to hyperdense
SOL with clear margins which showed strong homogenous
enhancement on post contrast scans [Figure 3], involving the

Address for correspondence: Dr. Deepak Agrawal, Department of Radio Diagnosis, Era’s Lucknow Medical College, Lucknow,
Uttar Pradesh, India. E-mail: deepak16june@gmail.com

Journal of Oral and Maxillofacial Radiology / January-April 2015 / Vol 3 | Issue 1 25

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Khanduri, et al.: Haemangioma of tongue
Figure 1: A 10-year-old girl with lobulated mass in posterior half of tongue
diagnosed as hemangioma. Photographic image shows a well-defined, reddish
pink lobulated mass (black arrow) with well-defined margins and smooth
surface in the posterior third of the tongue extending up to the right tonsilo-
lingular sulcus
Figure 3: 10-year-old girl with lobulated mass in posterior half of tongue
diagnosed as hemangioma. On computed tomography scan of neck, axial
images shows a well-defined moderate sized homogenously iso to hyperdense
space occupying lesion (large arrow) with clear margins with strong
homogenous enhancement on postcontrast scans (small arrow) was noted
base of the tongue and floor of mouth causing narrowing
of the oropharyngeal region extending posteriorly up to the
pre styloid parapharyngeal space, no evidence of any bony
destruction was noted. On magnetic resonance imaging
(MRI) a well-defined rounded area of signal alteration
iso to hypointense on T1-weighted, hyper-intense on
T2-weighted with multiple serpiginous flow voids with
strong homogenous enhancement on contrast with marked
enhancement of intra-tumoral vessels is noted at the base
of tongue extending up to the oropharynx [Figure 4].
Excision of the lesion was done with no postoperative
complications. With all the investigations, a diagnosis of
hemangioma of tongue was concluded.
DISCUSSION
Hemangiomas are common developmental vascular
abnormalities, head and neck regions are more commonly
involved mainly face, lips and oral mucosa, but the
26 Journal of Oral and Maxillofacial Radiology / January-April 2015 / Vol 3 | Issue 1
Figure 2: A 10-year-old girl with lobulated mass in posterior half of tongue
diagnosed as hemangioma. Transverse high resolution ultrasonography
of tongue through submandibular approach revealed a well-defined
homogeneously hyperechoic space occupying lesion (SOL) in the posterior
third of tongue (large arrow) and the Sol showed abnormally increased
vascularity on color Doppler suggesting a vascular etiology (small arrow)
Figure 4: 10-year-old girl with lobulated mass in posterior half of tongue
diagnosed as hemangioma. On magnetic resonance imaging, sagittal images
shows a well-defined rounded space occupying lesion with serpiginous flow
voids representing the intra tumoral vessels showing area of signal alterations
iso to slightly hyperintense on T1-weighted image (large arrow), hyperintense
on T2-weighted (small arrow) and homogenous enhancement on postcontrast
T1-weighted images (star)
tongue is rarely involved as in our case report. The term
“hemangioma” is misused for various vasculoformative
tumors, for this confusion, the International Society for
the Study of Vascular Anomalies has recently provided
guidelines to differentiate these two conditions, according
to the novel classification first published by Mulliken and
Glowacki in 1982.[5] Now vasculoformative tumors are
divided into Hemangioma and vascular malformations.
Hemangiomas are benign tumors of endothelial cells and
are of two types capillary and cavernous hemangioma.
Histologically hemangiomas are classified as capillary
and cavernous types. A capillary hemangioma also called
as “strawberry” birthmark consists of an abnormal
overgrowth of tiny blood vessels. Capillary hemangiomas
may not be present at birth but appear within the first
6 months of life. They usually begin to decrease in size
between 12 and 15 months of age. Most regress nearly
completely by 5 or 6 years of age. Capillary hemangiomas
are more common in premature infants and in girls
while cavernous hemangioma is a benign, congenital red
or purple tumor consisting of enlarged blood vessels.
The scalp, face, and neck are the most common sites,
but these tumors have been found in the liver and other
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Khanduri, et al.: Haemangioma of tongue
organs. Superficial cavernous hemangiomas are friable
and easily infected if the skin is broken. Treatment
includes observation, irradiation, sclerosing solutions,
and laser surgery and excisional surgery. Cavernous
hemangiomas are also called as angioma cavernosum,
cavernoma.[6] Hemangiomas are dark red to purplish blue,
may be superficial or deep, may be sessile or pedunculated,
they blanch on application of pressure, can vary from
millimeters to centimeters in size.[7,8]
Radiological investigations are mainly done if the tumor
is compressing a vital anatomical structure like a nerve or
a vessel. CT and MRI are used for assessing the volume
of hemangiomas and vascular malformations and can also
help to differentiate the tumor from its differentials and
also help in assessing the its size, extension and location,
as well as for follow-up after treatment. Color Doppler can
help in differentiating between vascular and nonvascular
lesions and can help to localize the feeding vessel, further
helping in concluding the treatment plan. Baba and Kato
reported a case of hemangioma with pleboliths in the floor
of the mouth and Doppler ultrasonography, CT, MRI was
used to diagnose the lesion.[3]
Hemangiomas are found in association with various
syndromes like Osler – Webber – Rendu syndrome,
Sturge – Webber syndrome and Blue rubber bleb nevus
syndrome. Differential diagnosis in our case could be
lingual thyroid, thyroglossal duct cyst, lymphangioma,
hypertrophy of ligular tonsils, dermoid and lipoma. The
presence of vascularity in hemangioma differentiates it
from the above condition.
Hemangioma of tongue needs special consideration due to
susceptibility to trauma, bleeding and ulceration, it may also
become a cause of difficulty in breathing and dysphagia.
Most of the haemangiomas are asymptomatic and can
be treated conservatively. If symptoms like mass effect,
dysphagia, dyspnea or haemorrhage are present then
symptomatic lesions should, when possible, be resected
which is curative. Different treatment modalities are
available like intralesional and systemic corticosteroids,
sclerosing agents, embolization, excision (as in our case),
Journal of Oral and Maxillofacial Radiology / January-April 2015 / Vol 3 | Issue 1
electrolysis, thermacautry and laser photocoagulation. Now
a day’s sclerosing therapy is employed due to its efficacy
and ability to not destroy surrounding tissue.[9]
CONCLUSION
A rare case of hemangioma in the posterior third of tongue
in a 10-year-old female which appeared localized well
defined, reddish pink and lobulated mass with well-defined
margins on intra-oral examination with typical features
on ultrasonography and abnormally increased vascularity
on color Doppler suggesting a vascular etiology. Further
evaluation was done on contrast enhanced CT scan and
MRI which confirms its vascular nature and diagnosed as
a case of hemangioma.
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Cite this article as: Khanduri S, Agrawal D, Varshney G, Singh N.
Haemangioma of tongue: A rare case report. J Oral Maxillofac Radiol
2015;3:25-7.
Source of Support: Nil. Conflict of Interest: None declared.
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