- See:
-
Calcinosis:
-
Hemangioma of bone
- Discussion:
- a benign, vascular tumor that occurs in children, usually in limbs or trunk;
- hemangioma may be congenital, appearing as solitary tumor that infiltrates local tissue & adjacent neurovascular structures;
- most common form of hemangioma has infiltrative margins composed of both large and small vessels;
- most common soft tissue lesions in children are vascular in origin;
- despite their vascular origin, hemangiomas do not metastisize or undergo malignant transformation;
- with age, growth of hemangioma will slow and in many cases regress by ages 5-7 years;
- Kasabach-Merritt syndrome:
- life threatening syndrome in which hemangiomas occur with
thrombocytopenia;
-
diff dx:
-
AV malformations:
- ultrasound should help distinguish AVN from hemangioma;
-
Venous Malformations:
- may be present at birth but often are not noticed until 1 year of age;
- they engorge when dependent, decompress when elevated, & enlarge with trauma, puberty, pregnancy, or use of OC;
-
synovial sarcoma
-
specific types of hemangioma:
-
capillary (small vessel) hemangiomas:
- non invasive & usually smaller & more cellular than cavernous hemangiomas;
- superficial "strawberry lesion" or deeper blue lesion that proliferates and grows faster than the child by 2 months of age;
- this superficial form often does not show deep soft tissue swelling;
- shows
spontaneous involution by 4-5 yrs of age;
-
cavernous hemangiomas:
- invasive tumors which often manifest as a deep soft tissue mass, often involving the thigh;
- intramuscular hemangiomas may engorged with blood during activity sometimes causing pain, and in contrast,
w/ rest the swelling and pain abate;
- may contain
calcifications or phleboliths (seen on x-ray);
- check for palpable thrill or audible bruit;
- superficial skin changes are often not present;
-
synovial hemangioma:
- occurs mainly in the knee and presents as recurrent painful monoarticular hemarthrosis;
- mass may diminish in size with elevation;
- Clinical Presentation:
- look for firm mass, that may demonstrate reddish or blue color depending on tumor depth;
- mass may vary in size and may become larger (and more painful) w/ physical activity, or w/ standing but may reduce in
size (and become less tender) once the patient is flat on the examining table;
- size will not reduce with simple elevation;
- look for associated dilated adjacent veins;
- some patients may demonstrate intermittent bleeding and ulceration;
- hand:
- capillary and cavernous
- not seen at birth, rapid growth, slow involution;
- starts as small reddish spot & grows to raised lesion
- most disappear by age 8 (in constrast vascular type hand masses which appear during adulthood will not be due to hemangioma);
- may ulcerate
- treatment: supportive, non-operative, expect regression;
- Radiographs:
-
ossification of soft tissue is a characteristic finding;
- check for phleboliths (smooth, round radiodense areas) and/or periosteal thickening of nearby bone;
- phleboliths may also be seen in
vascular malformations;
-
venography:
- best test for showing caverous spaces of hemangioma is venography;
-
bone scans:
- show little or no increase in radioisotope uptake;
-
MRI:
- MRI is superior to CT for imaging lesion from surrounding normal tissue;
- presence of
fat & serpentine blood vessels provides distinctive appearance;
- shows markedly increased signal on
T1 images &
T2 images;
- hemorrhage & thrombosis can also cause increase in signal on T1-images;
- Treatment:
- in most patients non operative treatment is appropriate;
- patients are provided w/ compression stockings;
- embolization may be an option for some patients;
- localized or systemic steroids may be helpful in some cases;
- in the report by
Peter Tang MD et al (CORR 2002. p 205-210), the authors report on 89 patients with soft tissue hemangiomas collected over a 20 year period;
- the authors note that intralesional or marginal excision for symptomatic hemangiomas yielded satisfactory results for pain relief, functional
recovery, and avoided recurrence;
- they authors felt that a hemangioma of the soft tissues is a benign lesion in which more aggressive surgery (wide or radical excision)
or other modalities such as radiation usually are not warranted
- aggressive stage 3 tumor:
- requires en bloc wide marginal excision;
- excision with a smaller margin is associated w/ recurrence rate of 30%;
Malignant hemangioendothelioma of bone.
Skeletal changes associated with vascular malformations.
Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment.
Orthopaedic treatment of hemangiomatous hypertrophy of the lower extremity.
Distinguishing Soft-Tissue Hemangiomas From Vascular Malformations Using Technetium-Labeled Red Blood Cell Scintigraphy.
Synovial haemangioma of the knee joint: Diagnosis by arthroscopy. D Paley, RW Jackson Arthroscopy. Vol 2, 1986, p 174-177.
Soft tissue hemangioma is a common soft tissue neoplasm. Eur J Radiol 2004;49:179-181.
