Objectives: The histological spectrum of hemangiomas of the skull base and maxillofacial skeleton was evaluated to help explain the variability of the clinical and radiological presentation of this tumor. Design: Retrospective case series. Participants: Patients with surgically treated hemangiomas of the ear, sinuses, skull base, and maxillofacial bones. Method: Light microscopic appearance of surgical specimens. Results: Review of specimens from 23 tumors revealed two distinct histological patterns: 1) typical histology consisting of vascular spaces lined by endothelium and a thin layer of smooth muscle, and 2) osteofibrous histology that consisted of prominent fibrous tissue between vascular spaces associated occasionally with neo-osseogenesis. The osteofibrous histology was more prevalent in the sinonasal and anterior skull base regions compared to the internal auditory canal. Conclusions: Connective tissue and bony proliferation within hemangiomas vary according to tumor location and may have implications for the radiological appearance, ease of surgical resection, and associated morbidity.
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