Successful treatment of solitary intraosseous haemangioma of the femoral neck

Displaced humeral pathological fracture secondary to intraosseous hemangioma

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.

Imaging features of hemangioma in long tubular bones

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.

Multifocal intraosseous hemangioma: A case report

RATIONALE

Multifocal intraosseous hemangioma, which affects multiple body parts, is rare. The selection of appropriate lesion sites for biopsy and effective treatment in multifocal intraosseous hemangioma is challenging. Here, we report a case of multifocal intraosseous hemangioma.

PATIENT CONCERNS

A 49-year-old woman was admitted to our department with a chief complaint of aggravated lumber pain for 10 days.

DIAGNOSES

Radiographic imaging revealed lesions involving the bilateral ribs, lumbar vertebrae, ilium, pubis, and proximal femur. Open biopsy in the ilium established the pathological diagnosis of intraosseous hemangioma.

INTERVENTIONS

For the symptomatic lumbar spine, the patient selected radiotherapy as the initial treatment.

OUTCOMES

As of the one-year follow-up, no symptoms of recurrence have been observed.

LESSONS

This rare case demonstrates the importance of the selection of the appropriate lesion to confirm the diagnosis and effective treatment for patients with multifocal disease. Radiotherapy plays an important role in the treatment of patients with symptomatic vertebral hemangiomas without neurologic deficits.

[Skeletal hemangiomas]

Hemangiomas are benign tumors, which are mainly composed of neoplastic blood vessels. The exact pathogenesis is still unclear. They are the most common benign spinal tumors and also occur less commonly in the bones of the extremities. Hemangiomas are often clinically asymptomatic and are diagnosed as incidental findings. Women are affected more frequently than men (2:1). The X‑ray and computed tomography (CT) diagnostics typically demonstrate the classical honeycombing or vertically orientated lucencies separated by thickened cancellous bone in the affected skeletal section. Vertebral hemangiomas are hyperintense in both T1 and T2-weighted magnetic resonance imaging (MRI). The treatment of vertebral hemangiomas ranges from irradiation, embolization and vertebroplasty to operative decompression, resection of the tumor and instrumented stabilization. In the long bones intralesional curettage and bone grafting with additive osteosynthesis is the main treatment modality. The prognosis for osseous hemangiomas is good.