Lingual Cavernous Hemangioma

Diagnosis: Lingual Cavernous Hemangioma

Submitted by Dr. Alaa Saad to dermRounds

Clinical Presentation

Blue-red spongy tumor mass of tissues filled with blood involving the tongue. Submitted by Dr. Alaa Saad to dermRounds

Clinical History

Rapidly growing, bright red papule or plaque in infancy. Onset in first weeks of life. Assess for PHACES if large facial hemangioma. GLUT1 staining confirms diagnosis.

Treatment

Observation for small, uncomplicated. Propranolol 2-3 mg/kg/day for problematic hemangiomas (first-line). Topical timolol 0.5% for small, superficial. Pulsed dye laser for ulcerated or residual telangiectasia. Surgical excision for residual fibrofatty tissue.

Differential Diagnosis

• Vascular malformation • Kaposiform hemangioendothelioma • Tufted angioma • Pyogenic granuloma • Kaposi sarcoma • Neuroblastoma (metastatic) • Myofibroma

Key Learnings

• Infantile hemangioma: most common tumor of infancy — GLUT1 positive • Classic phases: proliferative (0-12 months) → plateau → involution (years) • Complete involution in ~50% by age 5, ~90% by age 9 • PHACES syndrome: large facial hemangiomas with posterior fossa, hemangioma, arterial, cardiac, eye, sternal defects • Alarming locations requiring treatment: periocular (amblyopia), airway (subglottic), ulcerated, large facial • Propranolol is the first-line treatment for problematic infantile hemangiomas — revolutionary since 2008 • Timolol 0.5% gel (topical) for small, superficial lesions

Tags: dermatology, kodachrome, Lingual Cavernous Hemangioma