Fine needle aspiration cytology of cellular hemangioma of infancy - A case report

BACKGROUND: Cellular hemangioma is a common benign vascular neoplasm of infants and children. The lesion typically occurs within the superficial dermis, where it is recognized as a strawberry nevus. Occasionally, this neoplasm is situated within deep soft tissues of the head or neck, with a particular predilection for the parotid gland region. Fine needle aspiration cytology (FNAC) of cellular hemangioma involving the parotid gland has been reported previously, but never confirmed by cytologic findings alone. We report the first case of infantile cellular hemangioma with sufficient characteristic cytologic features to be diagnosed by FNAC. CASE: A 3-month-old male presented with a rapidly enlarging, sensitive, solid, supraparotid mass. Ultrasound and computed tomography were performed but were nondiagnostic. Subsequent FNAC of the mass demonstrated a highly cellular specimen composed predominantly of elongated spindled cells arranged in three-dimensional coils and arcades. Immunohistochemistry demonstrated the endothelial origin of the spindled cells and confirmed the diagnosis of cellular hemangioma. CONCLUSION: Deeply situated cellular hemangiomas may pose a difficult diagnostic challenge to the clinician as well as to the radiologist. The infantile variant of this tumor enlarges rapidly, simulating an aggressive malignant tremor, and is occasionally accompanied by substantial compressive symptoms. Radiographic presentation of the lesion may be that of a solid tumor mass, unlike most of her hemangiomas. Precise cytologic diagnosis of infantile cellular hemangioma can be rendered on aspirated material and is crucial in planning conservative medical treatment.