Vascular Hamartoma of Orbit

Eleven years old female child presented with complaint of painful protrusion of left eye of twenty days duration. On examination, right eye was normal. In left eye there was eccentric proptosis which was down and out. There was well defined, lobulated, tender mass in superonasal quadrant with restricted movements. B scan of left orbit showed 16 X 8 mm sized hyper echoic and hypo echoic solid mass between superior rectus and globe nasally. CT Imaging of orbit revealed mass in superonasal quadrant enhancing with contrast. With pseudotumour, orbital cellulitis and vascular lesion as possible diagnosis in mind the child was started on T.Prednisolone 20 mg per day along with intravenous antibiotics. After 25 days mass reduced in size but it was still present. Excision biopsy was planned. Under general anaesthesia anterior orbitotomy was done and mass excision was carried out. On histopathological examination, there was fibro collagenous tissue with capillary sized, large irregular blood vessels lined by flattened endothelial cells with large aggregates of lymphocytes and focal collection of histiocytes diagnostic of vascular hamartoma. Left orbit and eye were normal after surgery. A hamartoma is a benign, focal malformation that resembles a neoplasm in the tissue of its origin. This is not a malignant tumor, and it grows at the same rate as the surrounding tissues. It is composed of tissue elements normally found at that site, but which are growing in a disorganized mass. They are often detected in the first decade of life. These vascular anomalies occasionally cause severe cosmetic or functional abnormalities due to recurrent haemorrhage into previously unrecognized lesion. Vascular hamartomas tend to be non encapsulated, spread into adjacent tissues and bleed profusely when manipulated. The histological finding of the anomaly tend to be mixed lymphatics, arterial and venous characteristics. The mass depending on its position can alter the globe position and result in amblyopia if not intervened at proper age. The treatment modalities include intralesional steroids and surgical removal of the mass, the route depending upon the position of the mass and its confirmation with histopathological examination.