PMC7424172_01
Pre-operative lateral view of left zygoma displaying obvious expansion.
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On clinical examination (Fig. 1), a smooth, painless, palpable and compressible, firm, soft tissue mass was observed in the left zygomatic area.
Coronal soft tissue CT scans obtained in 25 years-old Male: A circle shows heterogenous iso-density mass with discrete numerous low attenuation areas. A mass measuring 2.5 x 2 cm in size with well- contoured margin. which abutting on the left zygoma without radiographic signs of intra- bony involvement.
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Radiographic investigation including Computed tomography (Fig. 2) showed heterogenous iso-density mass with discrete numerous low attenuation areas.
Contrast enhanced Magnetic Resonance Images; (a, b) Coronal PD images: circles show heterogenous well-Defined hyperintense soft tissue mass with scattered hypointense spaces suggesting phleboliths "star" and (c) Sagittal T2 image shows hyperintense mass with surrounded non-uniform hypointense fatty tissue "arrowhead". The mass involved the zygomatic muscles and abutting on the left zygomatic bony complex.
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Further, Contrast Enhanced Magnetic Resonance Images (Fig. 3) showed heterogenous well-defined hyperintense soft tissue mass with scattered hypointense spaces suggesting phleboliths and non-uniform hypointense fatty tissue.
(a) Intraoperative surgical picture shows extended subciliary incision. (b) Post excisional macroscopic appearance of intramuscular mass measured 2.5 x 2 x 1.5 cm.
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Moreover, on consenting for surgical therapy under general anesthesia, the patient underwent complete excision of the intra-zygomaticus major muscle mass via an extended subciliary approach (Fig. 4a). An excisional biopsy was performed, a single mass of tissue was obtained which was well-circumscribed with hemorrhagic areas, rubbery in consistency, reddish in color, measured 2.5 x 2.0 x 1.5 cm (Fig. 4b).
(a) Histopathological analysis shows lobulated tumor composed of spindle cells; likely endothelial cells with pericytes. (b) Post-operative presentation of patient.
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Histopathologic evaluation of the lesion (Fig. 5a) revealed a lobulated tumor composed of spindle cells; likely endothelial cells with pericytes. Follow-up visit (Fig. 5b) revealed good healing with no complications in the area of zygomaticus major muscle.