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Powell GM, Littrell LA, Broski SM, Inwards CY, Wenger DE. Imaging features of intraosseous hemangiomas: beyond the mobile spine and calvarium. Skeletal Radiol 2023; 52:1739-1746. [PMID: 37052653 DOI: 10.1007/s00256-023-04339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Describe imaging features of intraosseous hemangiomas located outside of the mobile spine and calvarium. MATERIALS AND METHODS Imaging and medical records were retrospectively reviewed for cases of intraosseous hemangiomas located outside of the calvarium and mobile spine. Evaluation included patient demographics, histologic confirmation, and imaging characteristics. RESULTS Thirty-six patients were included (25 F, 11 M; mean age 54 ± 17 years, range 10-84 years) with 37 total lesions (70% axial and 30% appendicular skeleton). Mixed lytic and sclerotic features were identified on 83-85% radiographs and CTs. Amorphous increased density mimicking osteoid matrix was present on 38-45% radiographs and CTs. Classic honeycomb or radial pattern was identified on 45% of CTs. Osseous expansion and cortical permeation were common features. CT identified periosteal reaction in 24% of lesions. All hemangiomas had heterogeneous MRI signal and most moderately or avidly enhanced. Intralesional fat was identified on 78% MRIs, often as a minor component and only detected on 24% of CTs. A soft tissue mass was present on 52% of MRIs. FDG PET/CT mean SUVmax of 3.2 ± 0.6 (range 1.9-5.0). Lesional FDG activity relative to background marrow was increased in 75% of lesions. Lesions with cortical permeation had higher metabolic activity versus those without (3.5 ± 0.7 versus 2.2 ± 0.3, p = 0.041). CONCLUSION Intraosseous hemangiomas outside of the mobile spine and calvarium demonstrate more aggressive imaging features compared to vertebral hemangiomas, including cortical permeation, soft tissue mass, amorphous increased density mimicking osteoid matrix, and increased FDG activity.
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Affiliation(s)
- G M Powell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - L A Littrell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - S M Broski
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - C Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D E Wenger
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Kitajima H, Shioya A, Kadoguchi R, Han J, Sawano H, Yonezawa K, Shimizu Y, Hiromura K, Yokoyama M, Nojima T, Yamada S. A Unique Surgical Case of Ancient Calcified Intravascular Papillary Endothelial Hyperplasia in the Tibia with Knee Joint Osteoarthritis. Orthop Surg 2022; 14:3134-3138. [PMID: 36178022 DOI: 10.1111/os.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intravascular papillary endothelial hyperplasia (IPEH) is a reactive lesion histopathologically characterized by papillary growth of vascular endothelial cells. IPEH is most commonly found in the skin and subcutaneous tissues of the head, neck, and extremities. Furthermore, it has been reported to occur in oral surgery, but its occurrence in bone is extremely rare. CASE PRESENTATION We present the case of a 77-year-old man with a chief complaint of left knee arthralgia. The knee joint X-ray showed Kellgren-Lawrence grade 4 osteoarthritis and a mass lesion with decreased permeability within the bone in the medial part of the proximal tibia. Computerized tomography (CT) scan of the left knee showed a localized mass in the left proximal tibia with clear margins and granular internal calcification. The preoperative diagnosis was left knee osteoarthritis and a benign tumor of the left proximal tibia (enchondroma or hemangioma). The patient requested surgical treatment, so left total knee arthroplasty (TKA) and resection of the tumor were performed. The pathology revealed a rare intraosseous IPEH with marked calcification. CONCLUSIONS Since intraosseous IPEH could not be considered from the clinical findings, the pathological diagnosis was the decisive factor. This report showed the world's first case of intraosseous IPEH with marked calcification. Similar to the calcification of intraosseous hemangiomas, we considered the possibility that, in IPEH, the thrombus may fibrosis and organize in concentric circles, causing necrosis at the center and resulting in calcification. TKA was performed on the degenerative knee joint with IPEH, and a good patient outcome was obtained.
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Affiliation(s)
- Hironori Kitajima
- Department of Orthopaedic Surgery, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan.,Department of Pathology, Kanazawa Medical University Hospital, Ishikawa, Japan.,Department of Pathology, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Rie Kadoguchi
- Department of Pathology, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Jia Han
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hinako Sawano
- Department of Pathology, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Katsutaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Yoshiaki Shimizu
- Department of Orthopaedic Surgery, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Kentaro Hiromura
- Department of Orthopaedic Surgery, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Mitsuteru Yokoyama
- Department of Orthopaedic Surgery, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Takayuki Nojima
- Department of Pathology, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan.,Department of Pathology, Kanazawa Medical University Hospital, Ishikawa, Japan.,Department of Pathology, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
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Monroy D, Garcia J, Zarate SD, Belzarena AC. Displaced humeral pathological fracture secondary to intraosseous hemangioma. Radiol Case Rep 2022; 17:1609-1613. [PMID: 35313567 PMCID: PMC8933724 DOI: 10.1016/j.radcr.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 10/30/2022] Open
Abstract
Intraosseous hemangiomas are uncommon slow-growing benign bone tumors. Most of these lesions are located in the spine or skull and long bone location is rare. Here we present the case of a 63-year-old female with a pathological fracture of the left proximal humerus through an intraosseous hemangioma. Imaging features can be highly unspecific when these tumors are found in the long bones. In this case a pathological fracture obscured the diagnosis even further, prompting the need for tissue sampling to exclude an underlying malignancy.
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Cao L, Wen JX, Han SM, Wu HZ, Peng ZG, Yu BH, Zhong ZW, Sun T, Wu WJ, Gao BL. Imaging features of hemangioma in long tubular bones. BMC Musculoskelet Disord 2021; 22:27. [PMID: 33407312 PMCID: PMC7786894 DOI: 10.1186/s12891-020-03882-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background To investigate the imaging features of hemangiomas in long tabular bones for better diagnosis. Methods Twenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5]. Results Among 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI. Conclusions The long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.
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Affiliation(s)
- Lei Cao
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Jin-Xu Wen
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Shu-Man Han
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Hui-Zhao Wu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Zhi-Gang Peng
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Bao-Hai Yu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Zhi-Wei Zhong
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Tao Sun
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Wen-Juan Wu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China.
| | - Bu-Lang Gao
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
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