Indian Journal of Vascular and Endovascular Surgery

CASE REPORT
Year
: 2021  |  Volume : 8  |  Issue : 5  |  Page : 93--95

A rare neck mass: Hemangioma of external jugular vein


Devender Singh, Basavarajendra Anurshetru, Shalini Aryala 
 Department of Vascular and Endovascular Surgery, Yashoda Hospital, Hyderabad, Telangana, India

Correspondence Address:
Devender Singh
Department of Vascular and Endovascular Surgery, Yashoda Hospital, Hyderabad, Telangana
India

Abstract

Intraluminal primary tumors of the body veins are rare clinical entities with few cases have been reported in the literature. Hemangiomas as a primary tumor, arising in the jugular vein are extremely rare. We present a case of right neck mass, was initially treated as venous thrombosis and finally diagnosed with hemangioma of external jugular vein on histopathological examination. Although rare, this case highlights the need of suspicion of a vascular tumor in cases of neck swelling for proper investigation and treatment.



How to cite this article:
Singh D, Anurshetru B, Aryala S. A rare neck mass: Hemangioma of external jugular vein.Indian J Vasc Endovasc Surg 2021;8:93-95


How to cite this URL:
Singh D, Anurshetru B, Aryala S. A rare neck mass: Hemangioma of external jugular vein. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2022 Jan 22 ];8:93-95
Available from: https://www.indjvascsurg.org/text.asp?2021/8/5/93/324930


Full Text



 Introduction



Hemangiomas are common benign tumors which can develop in any part of the body. Despite their common nature, hemangiomas arising from the blood vessels are very rare and should be differentiated from other neoplasma of vascular origin such as hemangioendothelioma, hemangiopericytoma, hemangiosarcoma, and leiomyosarcoma. In this report, we present a very rare case of hemangioma which was originated from external jugular vein. The hemangioma was totally excised, and the histopathological examination confirmed the diagnosis.

 Case Report



We report the case of young male of 23 years, otherwise healthy referred to us as a case of right neck mass for the past 3 months [Figure 1]. Earlier he was diagnosed with right external jugular vein thrombosis and treated with anticoagulation for 3 months. As the patient did not find any improvement and moreover started having pain, he was referred. On examination, he had a nodule of 3 cm in diameter, tender, firm in consistency, not pulsatile, and free from superficial and underlying muscular layers was palpable along the course of the right external jugular vein. Color Doppler scan neither favored as thrombosis of external jugular vein nor any conclusive diagnosis. Hence, we decided to explore and proceed. Under local anesthesia, the part of the external jugular vein was ligated and excised [Figure 2]. Macroscopically, the lesion was reddish, not encapsulated, and tightly adherent to the wall, with no infiltration beyond the adventitia [Figure 3] and [Figure 4]. Histopathologic examination showed an aggregation of thin-walled capillaries with scant connective tissue and few dilated vascular channels which were consistent with external jugular vein hemangioma [Figure 5] and [Figure 6].The postoperative course was uneventful, and no recurrence was detected after 1 year of follow-up procedures.{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}

 Discussion



The first description of an intravascular benign tumor was given by Masson in 1923.[1] The only description of a hemangioma of the external jugular vein in a radiologic journal goes back to 1967, prior to the echographic era.[2] Clinically, it may occur as a painful or painless subcutaneous nodule slowly growing in size, sometimes with sign of venous thrombosis.[3] Usually, the mass appears as a neck lateral nodule simulating a cervical lymphadenopathy, as in our case and was treated with a course of antibiotics. When there was no recovery, he was subjected for a color Doppler which reported a thrombus in the external jugular vein. Although repeat scan at our center did not revealed any thrombus. Keeping a differential diagnosis of a vascular tumor in mind, a good application of color and power Doppler ultrasonography may demonstrate the proliferative nature of the lesion and can give clue to the diagnosis.[4] This was missed in our case. It is preferable to perform a surgical excision rather than an ultrasonographically guided biopsy because of the extensive bleeding of punctured vascular lesions; moreover, total excision allows a better histopathologic definition and is curative unless features of malignancy are present. As a matter of fact, definitive diagnosis requires histopathologic examination, and differential diagnosis should be made between benign tumors such as hemangioma, hemangioendothelioma, and hemangiopericytoma and malignant lesions such as hemangiosarcomas or leiomyosarcomas.[5] In our case of benign intravascular tumor, local excision was curative, and no recurrence has been reported so far. In conclusion, our case has highlighted the importance of keeping even rare case in the differential diagnosis for the proper management avoiding delay and unnecessary treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Masson P. Hemangioendotheliome vegetant intravasculaire. Bull Soc Anat Paris 1923;93:517.
2Meyers MA. Hemangioma of the external jugular vein. Radiology 1967;89:483-5.
3Harris EJ Jr., Taylor LM Jr., Porter JM. Epithelioid hemangioendothelioma of the external iliac vein: A primary vascular tumor presenting as traumatic venous obstruction. J Vasc Surg 1989;10:693-9.
4Sarteschi LM, Bonanomi G, Mosca F, Ferrari MJ. External jugular vein hemangioma occurring as a lateral neck mass. Ultrasound Med 1999;18:719-21.
5Schoen FJ. Blood Vessels. In: Cotran RS, Kumar V, Robbins SL, editors. Robbins Pathological Basis of Disease. Philadelphia: WB Saunders; 1994. p. 588.