Cystic bone angiomatosis: a case report treated with aminobisphosphonates and review of the literature

Systemic cystic angiomatosis mimicking metastatic cancer

BACKGROUND

Cystic angiomatosis is a rare benign disease presents with multiple lytic and sclerotic bone lesions mimicking a metastatic malignant neoplasia with less than 50 cases have been reported in literature so far.

CASE PRESENTATION

We reported a case of a 48-year-old woman who presented to an oncology clinic with multiple lytic and sclerotic bone lesions. Oncologic investigation for metastatic malignant neoplasia started. After that the negative results were obtained by evaluating the primary tumor site, a final diagnosis of cystic angiomatosis was made according to bone biopsy results.

CONCLUSIONS

Cystic angiomatosis is a rare disease with unpredictable prognosis. It can mimic metastatic malignancy especially when it presents at old age.

Asymptomatic Skeletal Cystic Angiomatosis May Be Managed Conservatively With Close Observation

Cystic angiomatosis (CA) is a rare disease characterized by the proliferation of vascular and lymphatic channels lined by a single layer of endothelial cells. CA may present with isolated skeletal or visceral disease. There is no consensus for the standard of care in these patients, and diverse regimens for CA have been reported, including observation, surgery, radiation, and a variety of medical therapies. We present a case of multifocal, isolated skeletal CA, treated with close observation alone and review the literature. We suggest that these cases may be safely followed without intervention and may be stable for prolonged periods of time.

Cystic angiomatosis skull lesion obliteration with neuroendovascular sclerotherapy as a unique treatment: case report

Cystic angiomatosis is a rare bone condition with complex presentation and difficult treatment. Current management strategies have poorly tolerated side effects and a low likelihood of disease eradication. The control of calvarial lesions that are symptomatic usually involves surgical excision and subsequent cranioplasty. This paradigm can present with a risk of morbidity and mortality depending on the anatomy of the lesion. Here, the authors present a novel approach to a difficult-to-treat occipital calvarial lesion directly overlying the transverse sinus, performing a small, partial-thickness craniectomy and alcohol sclerotherapy in a combined neurosurgery-neuroendovascular approach. At 3 years after treatment, the authors noted a complete, encouraging radiographic and clinical outcome.

Bisphosphonates as a therapeutic choice for multifocal epithelioid hemangioma of bone: A case report

RATIONALE

Epithelioid hemangioma (EH) of bone is an intermediate vascular tumor that can be locally aggressive. The optimum management of multifocal EH of bone is not well delineated. We described our experience treating one patient with multifocal EH of bone in an effort to document the effect of bisphosphonates in bone EH.

PATIENT CONCERNS

In this report, a 53-year old male patient presented with back pain which was initially been diagnosed of multiple bone metastatic carcinoma by 18F-FDG PET/CT scan and bone scintigraphy.

DIAGNOSIS

CT-guided bone biopsy of ilium indicated that puncture tissue had irregular hyperplasia of thick and thin-walled blood vessels, immunohistochemistry revealed positive staining for CD31 and CD34, negative for CAMTA-1, PCK and EMA, which confirmed the diagnosis of multiple EH.

INTERVENTIONS

The patient was treated with 4 times of intravenous Zometa (zoledronate, 4 mg each time) with average three-month interval. Bone metabolic markers including serum bone specific alkaline phosphatase (BALP) and type I collagen cross-linked C-terminal telopeptide (CTX) levels were closely monitored before and after use of bisphosphonates each time.

OUTCOME

BALP and CTX were significantly lowered following intravenous Zometa and the back pain improved with integrated therapy including bone graft fusion internal fixation surgery and vertebroplasty.

CONCLUSIONS

EH of multiple bones responded favorably to intravenous Zometa with improvement of bone metabolic markers. After 1 year on follow-up, the patient was doing well with no significant pain. We suggest that bisphosphonates should be considered in the treatment of multifocal osteolytic EH of bone.

Cystic angiomatosis, pleural effusion and multiple bone lesions mimicking a metastatic malignant neoplasia: a case report

BACKGROUND

We report a case of a patient with a rare clinical condition: cystic angiomatosis presenting as pleural effusion and multiple bone lesions mimicking a metastatic malignant neoplasia. With only about 50 such cases published in the literature, it is important to report the clinical presentation and proposed treatment and to share information about the clinical evolution in these patients.

CASE PRESENTATION

We report a case of a 45-year-old white man who presented to our hospital with ventilator-dependent pain. Chest tomography detected pleural effusion and multiple osteolytic bone lesions. Oncologic investigation for metastatic malignant neoplasia was started after exclusion of an infectious process. Imaging examinations revealed diffuse osteolytic lesions as well as cystic lesions of the spleen, with discrete glycolytic hypermetabolism visualized by positron emission tomography. After negative results were obtained by investigation of the primary tumor site and a bone biopsy, a final diagnosis of cystic angiomatosis was made.

CONCLUSIONS

In view of the fact that cystic angiomatosis is a heterogeneous disorder of unpredictable prognosis and uncertain treatment, it is necessary to disseminate new cases so that further studies may be undertaken to obtain further physiopathological findings and an effective treatment.

Diffuse Skeletal Hemangiomatosis Mimicking Metastastic Disease on 18F-FDG PET/CT

Diffuse skeletal hemangiomatosis is a rare vascular proliferation disorder involving multiple bones and may be confused with metastatic bone malignancy. We present a case of a 53-year-old man suffering back and proximal right femur pain underwent F-FDG PET/CT scan. Multiple hypermetabolic lesions of bone were concerning for metastatic carcinoma. Since no primary malignancy was found, open biopsy was performed and histologic examination led to a diagnosis of diffuse skeletal angiomatosis. This case highlighted the importance of including diffuse skeletal hemangiomatosis in the differential diagnosis of multiple hypermetabolic skeletal lesions on F-FDG PET/CT.

Vascular Floor of Mouth Mass with Unanticipated Intracranial, Orbital, and Vertebral Associated Involvements

We report on a case in which a blanching, unobtrusive oral growth proved to be a systemic threat. A blind, epileptic child presented with a bleeding oral floor mass of 4 weeks. Biopsy showed small, dilated vascular spaces with reactive fibroblasts. MRI indicated distribution of expansile lesions in the mandible, cranial base, and right orbit that had possibly contributed to the patient's years-long neurologic deficits. A subsequent bone scan indicated lesions in multiple axial bones. Histologic markers confirmed the presentation of a rare cystic vascular pathology. Cystic Angiomatosis is a disease of intraosseous vascular malformations with occasional visceral involvements. Oral and craniomaxillofacial cases are especially rare and presentations can involve neuropsychiatric deficits, sensory issues, and mucosal bleeding. While clinicians are often dismissive of intraoral bleeding because of the prevalence of periodontal disease, careful evaluation is nonetheless critical to rule out underlying diseases with a possibly significant systemic involvement.

Systemic Cystic Angiomatosis Mimicking Metastatic Cancer: A Case Report and Review of the Literature

Systemic cystic angiomatosis is a rare benign disorder due to the maldeveloped vascular and lymphatic system with less than 50 cases reported in literature so far. We report here a case of systemic cystic angiomatosis (SCA) with multisystem involvement affecting the neck, thyroid, thoracic cavity, and skeletal system. The patient initially presented in her 4th decade of life with isolated lymphangioma in the neck requiring surgery. However, she experienced full-blown manifestations of SCA in her 6th decade which closely mimicked metastatic cancer. The diagnosis of SCA could only be established after multiple biopsies. The radiological and histological features of SCA with its course over 31 years in this patient have been described.

Gorham-Stout Disease Presenting as Acute Unilateral Proptosis

Gorham-Stout disease (GSD) is a rare angiomatous disorder characterized by osteolysis. We report the case of a 66-year-old woman who developed sudden left eye proptosis and facial pain. Neuroimaging demonstrated a destructive mass involving the roof and lateral wall of the left orbit with adjacent abnormal orbital soft tissue. An initial biopsy of the soft tissue was nondiagnostic; however, transcranial biopsy of the orbital roof revealed an intraosseous cavernous angioma, with infiltration of orbital fat by angiomatous tissue. Despite resection of the orbital roof and lateral wall, the orbital lesion continued to expand, leading to signs of a compressive optic neuropathy. The patient then reported severe back pain, prompting imaging that demonstrated disseminated bony involvement of the axial skeleton, eventually leading to the diagnosis of GSD. The patient was treated with a bisphosphonate and a vascular endothelial growth factor inhibitor with stabilization of disease.

Cystic angiomatosis, a heterogeneous condition: Four new cases and a literature review

BACKGROUND

Cystic angiomatosis (CA) is a rare disorder causing bony cysts. It displays some similarity to Gorham-Stout disease (GSD), but has a much better local prognosis, despite the larger number of cysts. These 2 conditions also differ in terms of their location, visceral involvement, and response to treatment.

METHODS

We report 4 cases of CA, including 1 sclerosing form, which we compare with cases from a literature review performed with PRISMA methodology.

RESULTS

We reviewed 38 articles describing 44 other patients. Mean age at diagnosis for the 48 patients (our 4 patients + the 44 from the review) was 22.5 years, and 28 of the patients were men. The femur was involved in 81% (n = 39), the pelvis in 73% (n = 35), the humerus in 52% (n = 25), the skull in 48% (n = 23), and the vertebrae in 44% (n = 21). Visceral lymphangiomatosis (either clinical, or detected on autopsy) was also reported in 35% (n = 18) of the patients. The spleen was the most frequently involved organ (n = 12), followed by the lungs and pleura (n = 8). Liver cysts and/or chylothorax were rarely reported (5 cases), but were invariably fatal. Radiation therapy on bone or soft tissue masses was ineffective, as was interferon alpha, in the 2 patients in which this drug was tested. The efficacy of bisphosphonate was at best equivocal.

CONCLUSION

The progression of CA is unpredictable and treatments effective against GSD, such as bisphosphonates and radiotherapy, have proved ineffective for this condition. New treatments are thus urgently required.

Bone vascularization in normal and disease conditions

Bone vasculature is essential for many processes, such as skeletal development and growth, bone modeling and remodeling, and healing processes. Endothelium is an integral part of bone tissue, expressing a physiological paracrine function via growth factors and chemokines release, and interacting with several cellular lines. Alterations of the complex biochemical interactions between vasculature and bone cells may lead to various clinical manifestations. Two different types of pathologies result: a defect or an excess of bone vasculature or endothelium metabolism. Starting from the molecular basis of the interactions between endothelial and bone cells, the Authors present an overview of the recent acquisitions in the physiopathology of the most important clinical patterns, and the modern therapeutic strategies for their treatments.