Volume 7          Vascular Tumors of BoneHemangioma---------------------Case 146-151 & 801-832Cystic angiomatosis---------...
Vascular Tumors    of Bone
Hemangioma of    Bone
Hemangioma of Bone    Hemangioma of the skeletal system is rare and accounts for onlyabout 1% of all skeletal tumors. It i...
honeycomb appearance in both the axial and long bones due toreactive bone formation surrounding the vascular spaces. In th...
As far as treatment is concerned, many of these smaller lesionsare incidental findings that require no treatment whatsoeve...
CLASSICCase #14614 year malehemangioma tibia
Photomic
Case #147       45 year female with hemangioma ilium
Case #14847 year malehemangioma tibia
Bone scan
Axial T-2 MRI
Photomic
Higher power
Case #14949 year malehemangioma L-4vertebra
Lateral view
Coronal PD MRI
Sagittal PD MRI
Axial PD MRI
Bone scan
Case #150                               Coronal CT scan            T-11     30 year female with hemangioma thoracic spine
Axial CT scan
Case #151       25 year female with hemangioma skull
Case #80113 year femalehemangioma femur
Proximal end
Coronal T-1 MRI
Sagittal T-1 MRI
Axial proton density MRI
Photomic
2 months post oppins, cement andcancellous allograft
allograftLateral view               cement
Case #80227 year maleparosteal hemangiomafemur
AP view
Bone scan
Sagittal T-2 MRI
Axial T-2 MRI
Case #803Parosteal sclerosinghemangioma femur28 year female
Hemicortical resectionspecimen
Masson stain photomic
PlacementIM nail
Cement augmentation
Post op x-ray                radiolucent                cement
2.5 years later
Case #804Parostealhemangioma femur26 year male
Bone scan
Axial T-2 MRI
Case #80514 year malehemangioma femur
Another view
Case #80631 year femalesclerosing parostealhemangioma femur
Case #8074 year femalehemangioma humerus
Case #80835 year malepath fracture thruhemangioma femur
Skin overlying femur fracture
Close up cavernous hemangioma
Healed fractureat later date
Case #80926 year femalehemangioma tibia
AP view
Case #81021 year femalehemangioma tibia
Case #81126 year malehemangioma tibia
Axial T-2 MRI
Case #812        19 year female with hemangioma scapula
Axial T-2 MRI
Case #813       21 year female with hemangioma scapula
Case #814  31 yr female with sclerosing hemagioma mid clavicle
Case #81527 year femalehemangioma humerus
Case #816     30 year male with hemangioma radius & ulna
Lateral view
Case #817      41 year male with hemangioma distal radius
Case #818                bone                             phlebolith                              soft tissue24 year male ...
Case #81914 year femalehemangioma foot
Case #820       17 year male with hemangioma C-2 spine
Axial CT scan
Another axial cut
Axial T-1 MRI
Sagittal T-2 MRI
Case #821            47 year female with hemangioma C-4
Axial CT scan
Sagittal T-1 MRI
Sagittal T-2 MRI
Case #822                          Sagittal T-1 MRI   18 year male with hemangioma lumbo-dorsal spine
Sagittal T-2 MRI
Axial T-1 MRI
Case #82332 year malehemangioma T-11
CT scan
sagittal T-1 MRI
Sagittal T-2 MRI
Case #82460 year female withhemangioma lumbo-dorsal spine
Case #825     15 year female with hemangioma lumbar spine
Case #82624 year femalehemangioma T-12
Case #82725 year femalehemangioma skull
Lateral view
CT scan
Photomic
Case #82823 year malehemangioma skull
Case #82919 year malehemangiomafrontal bone
Case #830        31 year female with hemangioma skull
Case #831  36 year male with hemangioma superior pubic ramus
Bone detail
CT scan showing parosteal soft tissue component
Coronal T-2 MRI showing parosteal lesion
Axial gad contrast MRI
Photomic
Case #832       21 year male with hemangioma pubic bone
CysticAngiomatosis
CLASSICCase #15237 year femalecystic angiomatosisstarting 1st in prox humerus
Coronal protondensity MRI
Coronal T-2 MRI
CT scan
Photomic
Higher power
Post op ORIF withpins and cement
5 years later withosteoblastic spontaneoushealing response
Same healing responsein dorsal spine multi-focal disease over 5 yrs
Lateral view of spineat 5 yrs
CT scan chest at 6 years
CT scan with blastic response in dorsal spine
Another CT cut
Bone scan at 5 yrs
Blastic response in pelvis at 5 years
5 year responsein opposite right humerus
8 years later with IM nail infemur for stress pain
Hemangiomatosis
CLASSICCase #8335 year femalemulti-focal bonyhemangiomatosis
Skull changes
Rib changes
Photomic
Higher power
Case #8345.5 year malehemangiomatosisfemur
Distal femoral lesion
Proximal femorallesions
Coronal protondensity MRI
Photomic
Lymphangiomatosis     of Bone
CLASSIC       Case #835   15 year female with lymphangiomatosis of pelvis
Coronal T-2 MRI with bone & soft tissue lesions
Coronal gad contrast MRI
Axial T-2 MRI
Coronal T-2 MRIcystic changes in thigh
Axial proton density MRI
Photomic
Case #836    24 year female with lymphangiomatosis pelvis
Lymphangiogram showinglarge soft tissue disease
Case #837     12 year female with lymphangiomatosis pelvis
Case #83816 year female                       IM naillymphangiomatosisfemur with pre andpost op x-rays ofIM nailing proced...
Gorham’s disease
Gorham’s Disease   Gorham’s disease, sometimes referred to as disappearing bonedisease, is characterized by massive osteol...
CLASSIC Case #15336 year maleGorham’s diseaseseen initially left hipSpontaneous osteolysisfemoral head and neck
CT scan 3 years later shows massive osteolysis both hips
Coronal T-1 MRI at time of initial disease in left hip
Initial axial T-2 MRI with high signal changes left hip
Bone biopsy left hip                           osteoidPhotomic shows changes similar to hemangiomatosis
Higher power showing capillary vascular pattern
Changes in right hip3 years after onsetin left hip
Case #839   12 year male with Gorham’s disease skull and spine
AP view
Sagittal T-1 MRI showing skull defects
Another sagittal T-1 cut
Axial CT scan showing defects at C-1 level
boneBone biopsy photomic changes similar to lymphangiomatosis
Case #840 46 year female with Gorham’s disease L hip & pelvis
Hemangioendothelioma
Hemangioendothelioma  The hemangioendothelioma or epithelioid hemangioendotheliomais considered an intermediate grade vasc...
CLASSICCase #15435 year femalelow gradehemangioendotheliomadistal femur
AP x-ray followingopen biopsy
Photomic
Case #15511 year malehemangioendotheliomadistal tibia and talus
Curettement andbone grafting distaltibia
Photomic showing epitheliod cells
Case #156      35 year male with hemangioendothelioma rib
Photomic
Case #157                           T-7    46 year female with hemangioendothelioma T-7
CT scan T-7 level
Sagittal T-2 MRI showing evidence of cord compression
Photomic
Post op x-ray followingposterior decompressionand spinal instrumentation
Case #15869 year male high gradehemangioendotheliomadistal tibia and fibula
Lateral view
boneLow power photomic
Another photomic
Case #841 35 year female with hemangioendothelioma distal femur
Bone scan
Coronal T-1 MRI
Sagittal T-1 MRI
Axial T-2 MRI
Photomic
Case #842  19 year male with hemangioendothelioma distal femur
Coronal T-1 MRI
Case #84340 year malehemangioendotheliomawith path fracturemid shaft humerus
Photomic
6 years later andconversion to OGS
Different view at 6 yrs
Case #844   48 year female with hemangioendothelioma foot
Bone scan
Axial T-1 MRI
Sagittal T-1 MRI
Sagittal STIR MRI
Case #845 19 year male with hemangioendothelioma 4th metatarsal
Sagittal T-2 MRI
Case #84652 year malehemangioendotheliomahand
Bone scan
Case #847                       T-440 year femalehemangioendothelioma   T-5T4 and 5
T-4Lateral view               T-5
Myelogram 4 mos latershowing cord compressionAt T-5 level
Rib lesion same patient
Photomic
Immediate post oplateral x-ray withanterior rib graft
Solid fusion 4 yrs laterno recurrence
5 years post oplateral view showinganterior rib graft
High GradeAngiosarcoma of     Bone
High Grade angiosarcoma of Bone   High grade hemangiosarcoma of bone differs from the low gradehemangioendotheliomas of bo...
CLASSIC      Case #159          21 year male with angiosarcoma pelvis
Progressive disease at a later date
CT scan above sciatic notch level
CT scan just below the sciatic notch
CT scan at femoral head level
tumorCoronal T-1 MRI
tumorAxial T-1 MRI
Photomic
Higher power
Case #848        50 year male with angiosarcoma pelvis
CT scan
Bone scan
Coronal T-1 MRI
Axial T-2 MRI
Photomic
Immediate post op internal hemipelvectomy with THA
Case #84934 year maleangiosarcoma fibula
tumorCoronal proton density MRI
tumorAxial proton density MRI
Photomic
Case #849.1                             Bone Angiosarc        Cor T-1               T-2                   Gad     46 year ...
Sag T-1   T-2   Gad
Axial T-1         T-2            Gad
Case #85066 year maleangiosarcomatibia and fibula
Oblique view
Femur involved also
Photomic
Case #85160 year maleangiosarcoma femur
9 mos. Followingsegmental resectionautoclaving andreplacement over IMnail
Multifocal radial lesion at a later date
Low power photomic
Hemangiopericytom    a of Bone
Hemangiopericytoma of Bone   Hemagiopericytoma of bone is an extremely rare tumor arisingfrom the hemangiopericytes of Zim...
CLASSIC            Case #160 25 year female with benign hemangiopericytoma talus
AP view
Mortice view
Low power photomic
High power
Post op x-ray aftercurettement andcementation
22 years later with minimal pain with degenerative OA and           beaking at the talo-narvicular joint
Case #16125 year femalehemangiopericytoma(glomus tumor) distalphalanx index finger
Case #16255 year malemalignanthemangiopericytomapelvis
Higher power
Post op x-ray following wide surgical resection
Case #852  47 year female with metastatic hemangiopericytoma                 Proximal humerus
Bone scan
Coronal T-1 MRI
Photomic
Case # 85367 year femalemalignanthemangiopericytomahumerus with pathfracture
Another view
Photomic
Case #853.1 49 yr male with malignant hemangiopericytoma mid femur
Case #854   39 year female with benign hemangiopericytoma rib                   3 years apart
Case #85529 year femalemalignanthemangiopericytomathoracic spine
Laminogram cut
CT scan
Lipid Bone  Tumors
Parosteal Lipoma
Parosteal Lipoma   Lipid tumors of bone, unlike soft tissue fatty tumors, are extremelyrare clinical entities. The most co...
CLASSICCase #16364 year femaleparosteal lipomadistal humerus     spur
Axial T-1 MRI
Axial T-2 MRI
Case #163.1   AP & lat x-ray of a parosteal lipoma distal femur in   A 67 yr male showing diagnostic bony spur at base
spurCoronal and axial T-1 MRI
Axial T-2 FS MRI   Axial Gad
Case #16416 year femaleparosteal lipoma   spurmid femur
Bone scan
spurAxial CT scan
Case #165                             spur  25 year female with parosteal lipoma 5th metacarpal
Case #85929 year female     spurparosteal lipomaproximal humerus
spurAxial T-1 MRI
spurCoronal T-1 MRI
Case #860               spur  74 year female with parosteal lipoma prox humerus
Intramedullary    Lipoma
Intramedullary Lipoma   Intramedullary lipomas are extremely rare conditions with approx-imately 30 cases in the world lit...
CLASSIC Case #16640 year femaleintramedullary lipomahumerus
Coronal T-1 MRI
Intramedullary lipoma Case #166.131 year male withpainless lytic lesionin proximal humerus
CT scan
Cor T-1   T-2   Gad
Axial T-2   Gad
Sag T-2   Gad
Case #166.2                   Intramedullary lipoma      45 year male with incidental finding in right shoulder
Sag T-1   T-2Gad
Axial T-1   T-2     Gad
Case #166.2                    Bone and soft tissue lipomaCT scan of a 54 year old femalewith a painless mass in axilla fo...
3D CT scan recon
Sag T-1   Gad
Axial T-1   T-2   Gad
Case #166.3                 Combined bone and soft tissue lipoma     69 year female with incidental findings in thigh and ...
Cor T-1   Gad
Axial T-1    T-1     Gad    Gad
Case #167                    CT scan53 year male withossifying lipomaos calcis
Another CT scan
Case #167.1                                Cystic lipoma        31 year old male with incidental finding in foot
Sag T-1         T-2          Gad
Axial T-1         T-2            Gad
Cor T-1   Gad
Case #167.2                                    Lipoma              50 year male with mild heal pain for 1 year
Sag T-1   STIR  Gad
Case #16850 year femaleossifying lipomadistal femur
Case #168.1                         Intramedullary lipoma         31 year male with incidental finding in distal femur
Cor T-1   T-2 FS
Axial T-1   T-2 FS
Sag T-1   T-2 FS
Case #860.1  33 year female with intramedullary lipoma prox tibia
Coronal T-1 MRI
Axial T-1 MRI
Case #860.2    24 year male with intramedullary lipoma os calcis
Sagittal T-1 MRI
Coronal T-1 MRI
Case #860.3    Sagittal CT scan       55 year female with intracortical lipoma
Coronal T-1 MRI
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Volume 7

  1. 1. Volume 7 Vascular Tumors of BoneHemangioma---------------------Case 146-151 & 801-832Cystic angiomatosis-------------Case 152Hemangiomatosis----------------Case 833-834Lymphangiomatosis-------------Case 835-838Gorham’s disease----------------Case 153 & 839-840Hemangioendothelioma---------Case 154-158 & 841-847High grade angiosarcoma-------Case 159 & 848-851Hemangiopericytoma------------Case 160-162 & 852-855 Lipid Tumors of BoneParosteal lipoma------------------Case 163-165 & 859-60Intramedullary lipoma-----------Case 166-168 & 856-860Intracortical lipoma--------------Case 860.3
  2. 2. Vascular Tumors of Bone
  3. 3. Hemangioma of Bone
  4. 4. Hemangioma of Bone Hemangioma of the skeletal system is rare and accounts for onlyabout 1% of all skeletal tumors. It is slightly more common infemales with the most common location being the skull, and spinalcolumn, and the least common location being the appendicularskeleton where it is seen typically in long bones such as thehumerus, femur and tibia. The presents of asymptomatic incidentalhemangiomas of the vertebral bodies at autopsy have been notedin as high as 10% of autopsy studies. The hemangioma is consideredA hamartomatous dysplastic process similar to fibrous dysplasia.It can be monstotic or polyostotic. The lesions occur during thedevelopmental years but are frequently not diagnosed until middleage when they are picked up as incidental findings, perhaps duringthe performance of an MRI study of the axial skeleton. Radiographically, the hemangioma is a lytic process with fairlygeographic borders and the lesions tend to have a motheaten or
  5. 5. honeycomb appearance in both the axial and long bones due toreactive bone formation surrounding the vascular spaces. In thecase of the axial skeleton, the characteristic radiographic feature isa vertically oriented honeycomb pattern. In flat bones, such as theiliac crest or the calvarium, the lesion may have a soap-bubblyor sunburst appearance, especially in the calvarium where theselesions are typically seen. Because of the osteoblastic response tothe vascular dysplasia, the radiographic appearance can be similarto that of an osteoid osteoma or an osteoblastoma. With MRIimaging, one may find a soft tissue component with the bony lesion,especially in the appendicular skeleton. Histologically, these lesionstend to be grossly bloody in appearance with large vascular sinusoidslined by a single layer of flat-appearing endothelial cells filledwith blood. Occasionally, one will see an epithelioid pattern tothe endothelial cells that gives them a more cube-like appearancesimilar to the histological appearance of an epithelioid low gradehemangioendothelioma.
  6. 6. As far as treatment is concerned, many of these smaller lesionsare incidental findings that require no treatment whatsoever. How-ever, with larger lesions, especially in the vertebral column, theremay be mechanical collapse associated with spinal cord compressionthat might necessitate curettement of the lesion with bone graftingand instrumentation. Also in the spinal area,larger lesions mayrequire embolization therapy prior to surgery to reduce hemorrhageat the time of exploration. Occasionally, low dose radiation therapycan reduce the lytic process produced by these dysplastic lesions.
  7. 7. CLASSICCase #14614 year malehemangioma tibia
  8. 8. Photomic
  9. 9. Case #147 45 year female with hemangioma ilium
  10. 10. Case #14847 year malehemangioma tibia
  11. 11. Bone scan
  12. 12. Axial T-2 MRI
  13. 13. Photomic
  14. 14. Higher power
  15. 15. Case #14949 year malehemangioma L-4vertebra
  16. 16. Lateral view
  17. 17. Coronal PD MRI
  18. 18. Sagittal PD MRI
  19. 19. Axial PD MRI
  20. 20. Bone scan
  21. 21. Case #150 Coronal CT scan T-11 30 year female with hemangioma thoracic spine
  22. 22. Axial CT scan
  23. 23. Case #151 25 year female with hemangioma skull
  24. 24. Case #80113 year femalehemangioma femur
  25. 25. Proximal end
  26. 26. Coronal T-1 MRI
  27. 27. Sagittal T-1 MRI
  28. 28. Axial proton density MRI
  29. 29. Photomic
  30. 30. 2 months post oppins, cement andcancellous allograft
  31. 31. allograftLateral view cement
  32. 32. Case #80227 year maleparosteal hemangiomafemur
  33. 33. AP view
  34. 34. Bone scan
  35. 35. Sagittal T-2 MRI
  36. 36. Axial T-2 MRI
  37. 37. Case #803Parosteal sclerosinghemangioma femur28 year female
  38. 38. Hemicortical resectionspecimen
  39. 39. Masson stain photomic
  40. 40. PlacementIM nail
  41. 41. Cement augmentation
  42. 42. Post op x-ray radiolucent cement
  43. 43. 2.5 years later
  44. 44. Case #804Parostealhemangioma femur26 year male
  45. 45. Bone scan
  46. 46. Axial T-2 MRI
  47. 47. Case #80514 year malehemangioma femur
  48. 48. Another view
  49. 49. Case #80631 year femalesclerosing parostealhemangioma femur
  50. 50. Case #8074 year femalehemangioma humerus
  51. 51. Case #80835 year malepath fracture thruhemangioma femur
  52. 52. Skin overlying femur fracture
  53. 53. Close up cavernous hemangioma
  54. 54. Healed fractureat later date
  55. 55. Case #80926 year femalehemangioma tibia
  56. 56. AP view
  57. 57. Case #81021 year femalehemangioma tibia
  58. 58. Case #81126 year malehemangioma tibia
  59. 59. Axial T-2 MRI
  60. 60. Case #812 19 year female with hemangioma scapula
  61. 61. Axial T-2 MRI
  62. 62. Case #813 21 year female with hemangioma scapula
  63. 63. Case #814 31 yr female with sclerosing hemagioma mid clavicle
  64. 64. Case #81527 year femalehemangioma humerus
  65. 65. Case #816 30 year male with hemangioma radius & ulna
  66. 66. Lateral view
  67. 67. Case #817 41 year male with hemangioma distal radius
  68. 68. Case #818 bone phlebolith soft tissue24 year male with bone & soft tissue hemangioma hand
  69. 69. Case #81914 year femalehemangioma foot
  70. 70. Case #820 17 year male with hemangioma C-2 spine
  71. 71. Axial CT scan
  72. 72. Another axial cut
  73. 73. Axial T-1 MRI
  74. 74. Sagittal T-2 MRI
  75. 75. Case #821 47 year female with hemangioma C-4
  76. 76. Axial CT scan
  77. 77. Sagittal T-1 MRI
  78. 78. Sagittal T-2 MRI
  79. 79. Case #822 Sagittal T-1 MRI 18 year male with hemangioma lumbo-dorsal spine
  80. 80. Sagittal T-2 MRI
  81. 81. Axial T-1 MRI
  82. 82. Case #82332 year malehemangioma T-11
  83. 83. CT scan
  84. 84. sagittal T-1 MRI
  85. 85. Sagittal T-2 MRI
  86. 86. Case #82460 year female withhemangioma lumbo-dorsal spine
  87. 87. Case #825 15 year female with hemangioma lumbar spine
  88. 88. Case #82624 year femalehemangioma T-12
  89. 89. Case #82725 year femalehemangioma skull
  90. 90. Lateral view
  91. 91. CT scan
  92. 92. Photomic
  93. 93. Case #82823 year malehemangioma skull
  94. 94. Case #82919 year malehemangiomafrontal bone
  95. 95. Case #830 31 year female with hemangioma skull
  96. 96. Case #831 36 year male with hemangioma superior pubic ramus
  97. 97. Bone detail
  98. 98. CT scan showing parosteal soft tissue component
  99. 99. Coronal T-2 MRI showing parosteal lesion
  100. 100. Axial gad contrast MRI
  101. 101. Photomic
  102. 102. Case #832 21 year male with hemangioma pubic bone
  103. 103. CysticAngiomatosis
  104. 104. CLASSICCase #15237 year femalecystic angiomatosisstarting 1st in prox humerus
  105. 105. Coronal protondensity MRI
  106. 106. Coronal T-2 MRI
  107. 107. CT scan
  108. 108. Photomic
  109. 109. Higher power
  110. 110. Post op ORIF withpins and cement
  111. 111. 5 years later withosteoblastic spontaneoushealing response
  112. 112. Same healing responsein dorsal spine multi-focal disease over 5 yrs
  113. 113. Lateral view of spineat 5 yrs
  114. 114. CT scan chest at 6 years
  115. 115. CT scan with blastic response in dorsal spine
  116. 116. Another CT cut
  117. 117. Bone scan at 5 yrs
  118. 118. Blastic response in pelvis at 5 years
  119. 119. 5 year responsein opposite right humerus
  120. 120. 8 years later with IM nail infemur for stress pain
  121. 121. Hemangiomatosis
  122. 122. CLASSICCase #8335 year femalemulti-focal bonyhemangiomatosis
  123. 123. Skull changes
  124. 124. Rib changes
  125. 125. Photomic
  126. 126. Higher power
  127. 127. Case #8345.5 year malehemangiomatosisfemur
  128. 128. Distal femoral lesion
  129. 129. Proximal femorallesions
  130. 130. Coronal protondensity MRI
  131. 131. Photomic
  132. 132. Lymphangiomatosis of Bone
  133. 133. CLASSIC Case #835 15 year female with lymphangiomatosis of pelvis
  134. 134. Coronal T-2 MRI with bone & soft tissue lesions
  135. 135. Coronal gad contrast MRI
  136. 136. Axial T-2 MRI
  137. 137. Coronal T-2 MRIcystic changes in thigh
  138. 138. Axial proton density MRI
  139. 139. Photomic
  140. 140. Case #836 24 year female with lymphangiomatosis pelvis
  141. 141. Lymphangiogram showinglarge soft tissue disease
  142. 142. Case #837 12 year female with lymphangiomatosis pelvis
  143. 143. Case #83816 year female IM naillymphangiomatosisfemur with pre andpost op x-rays ofIM nailing procedure pre op bowing
  144. 144. Gorham’s disease
  145. 145. Gorham’s Disease Gorham’s disease, sometimes referred to as disappearing bonedisease, is characterized by massive osteolysis in children or youngadults and is usually associated with the presence of benigncavernous hemangiomas or lymphangiomas of bone. This strangecondition usually affects a particular area (such as the spine or thehip) but can involve multiple bones of that area and tends to resolvespontaneously.
  146. 146. CLASSIC Case #15336 year maleGorham’s diseaseseen initially left hipSpontaneous osteolysisfemoral head and neck
  147. 147. CT scan 3 years later shows massive osteolysis both hips
  148. 148. Coronal T-1 MRI at time of initial disease in left hip
  149. 149. Initial axial T-2 MRI with high signal changes left hip
  150. 150. Bone biopsy left hip osteoidPhotomic shows changes similar to hemangiomatosis
  151. 151. Higher power showing capillary vascular pattern
  152. 152. Changes in right hip3 years after onsetin left hip
  153. 153. Case #839 12 year male with Gorham’s disease skull and spine
  154. 154. AP view
  155. 155. Sagittal T-1 MRI showing skull defects
  156. 156. Another sagittal T-1 cut
  157. 157. Axial CT scan showing defects at C-1 level
  158. 158. boneBone biopsy photomic changes similar to lymphangiomatosis
  159. 159. Case #840 46 year female with Gorham’s disease L hip & pelvis
  160. 160. Hemangioendothelioma
  161. 161. Hemangioendothelioma The hemangioendothelioma or epithelioid hemangioendotheliomais considered an intermediate grade vascular sarcoma arising fromendothelial cells. It occurs more commonly in males than femalesand is found typically in the femur, tibia ,axial skeleton and ribs.The most common age group is 20 thru 50 years. The lower gradelesions behave clinically very much like a hemangioma of bonebut the higher grade hemangioendotheliomas are more aggressive,require more aggressive treatment surgically, and can be helpedwith adjuvant radiation therapy.
  162. 162. CLASSICCase #15435 year femalelow gradehemangioendotheliomadistal femur
  163. 163. AP x-ray followingopen biopsy
  164. 164. Photomic
  165. 165. Case #15511 year malehemangioendotheliomadistal tibia and talus
  166. 166. Curettement andbone grafting distaltibia
  167. 167. Photomic showing epitheliod cells
  168. 168. Case #156 35 year male with hemangioendothelioma rib
  169. 169. Photomic
  170. 170. Case #157 T-7 46 year female with hemangioendothelioma T-7
  171. 171. CT scan T-7 level
  172. 172. Sagittal T-2 MRI showing evidence of cord compression
  173. 173. Photomic
  174. 174. Post op x-ray followingposterior decompressionand spinal instrumentation
  175. 175. Case #15869 year male high gradehemangioendotheliomadistal tibia and fibula
  176. 176. Lateral view
  177. 177. boneLow power photomic
  178. 178. Another photomic
  179. 179. Case #841 35 year female with hemangioendothelioma distal femur
  180. 180. Bone scan
  181. 181. Coronal T-1 MRI
  182. 182. Sagittal T-1 MRI
  183. 183. Axial T-2 MRI
  184. 184. Photomic
  185. 185. Case #842 19 year male with hemangioendothelioma distal femur
  186. 186. Coronal T-1 MRI
  187. 187. Case #84340 year malehemangioendotheliomawith path fracturemid shaft humerus
  188. 188. Photomic
  189. 189. 6 years later andconversion to OGS
  190. 190. Different view at 6 yrs
  191. 191. Case #844 48 year female with hemangioendothelioma foot
  192. 192. Bone scan
  193. 193. Axial T-1 MRI
  194. 194. Sagittal T-1 MRI
  195. 195. Sagittal STIR MRI
  196. 196. Case #845 19 year male with hemangioendothelioma 4th metatarsal
  197. 197. Sagittal T-2 MRI
  198. 198. Case #84652 year malehemangioendotheliomahand
  199. 199. Bone scan
  200. 200. Case #847 T-440 year femalehemangioendothelioma T-5T4 and 5
  201. 201. T-4Lateral view T-5
  202. 202. Myelogram 4 mos latershowing cord compressionAt T-5 level
  203. 203. Rib lesion same patient
  204. 204. Photomic
  205. 205. Immediate post oplateral x-ray withanterior rib graft
  206. 206. Solid fusion 4 yrs laterno recurrence
  207. 207. 5 years post oplateral view showinganterior rib graft
  208. 208. High GradeAngiosarcoma of Bone
  209. 209. High Grade angiosarcoma of Bone High grade hemangiosarcoma of bone differs from the low gradehemangioendotheliomas of bone in that they are very aggressive,lytic, destructive tumors usually occurring in the lower extremitiesof young adults that carry an extremely poor prognosis becauseof the high incidence of pulmonary metastases. These lesions, asopposed to the hemangioendotheliomas, have very little osteoblasticresponse to the infiltrate and take on the radiographic appearance ofa high grade spindle cell sarcoma such as a malignant fibrous histio-cytoma or a fibrosarcoma of bone. As with the hemangioendo-thelioma, they can be multifocal in nature but the more aggressivelesions tend to be solitary and lytic with permeative lysis throughoutthe bone. There are only about 30 cases described in the worldliterature showing the extreme rarity of this lesion. This aggressivesarcoma requires aggressive surgical treatment along with radiationand chemotherapy with a 50% chance of a five year survival.
  210. 210. CLASSIC Case #159 21 year male with angiosarcoma pelvis
  211. 211. Progressive disease at a later date
  212. 212. CT scan above sciatic notch level
  213. 213. CT scan just below the sciatic notch
  214. 214. CT scan at femoral head level
  215. 215. tumorCoronal T-1 MRI
  216. 216. tumorAxial T-1 MRI
  217. 217. Photomic
  218. 218. Higher power
  219. 219. Case #848 50 year male with angiosarcoma pelvis
  220. 220. CT scan
  221. 221. Bone scan
  222. 222. Coronal T-1 MRI
  223. 223. Axial T-2 MRI
  224. 224. Photomic
  225. 225. Immediate post op internal hemipelvectomy with THA
  226. 226. Case #84934 year maleangiosarcoma fibula
  227. 227. tumorCoronal proton density MRI
  228. 228. tumorAxial proton density MRI
  229. 229. Photomic
  230. 230. Case #849.1 Bone Angiosarc Cor T-1 T-2 Gad 46 year male smoker with fibular head mass for 3 months
  231. 231. Sag T-1 T-2 Gad
  232. 232. Axial T-1 T-2 Gad
  233. 233. Case #85066 year maleangiosarcomatibia and fibula
  234. 234. Oblique view
  235. 235. Femur involved also
  236. 236. Photomic
  237. 237. Case #85160 year maleangiosarcoma femur
  238. 238. 9 mos. Followingsegmental resectionautoclaving andreplacement over IMnail
  239. 239. Multifocal radial lesion at a later date
  240. 240. Low power photomic
  241. 241. Hemangiopericytom a of Bone
  242. 242. Hemangiopericytoma of Bone Hemagiopericytoma of bone is an extremely rare tumor arisingfrom the hemangiopericytes of Zimmerman, which are smoothmuscle contractile cells that lie outside the capillary tubes of thevascular system peripherally and control the flow of blood toperipheral tissue. Hemangiopericytomas can range from very lowgrade tumors, such as the glomus tumor seen in the distalphalanges of young adults, to the more aggressive, malignanthemangiopericytoma seen in the more proximal parts of the body,such as the pelvis, spine or femur. The later can behave like asarcoma and metastasize to the lung. There have only been a fewcases of this tumor reported in the literature in large bones.
  243. 243. CLASSIC Case #160 25 year female with benign hemangiopericytoma talus
  244. 244. AP view
  245. 245. Mortice view
  246. 246. Low power photomic
  247. 247. High power
  248. 248. Post op x-ray aftercurettement andcementation
  249. 249. 22 years later with minimal pain with degenerative OA and beaking at the talo-narvicular joint
  250. 250. Case #16125 year femalehemangiopericytoma(glomus tumor) distalphalanx index finger
  251. 251. Case #16255 year malemalignanthemangiopericytomapelvis
  252. 252. Higher power
  253. 253. Post op x-ray following wide surgical resection
  254. 254. Case #852 47 year female with metastatic hemangiopericytoma Proximal humerus
  255. 255. Bone scan
  256. 256. Coronal T-1 MRI
  257. 257. Photomic
  258. 258. Case # 85367 year femalemalignanthemangiopericytomahumerus with pathfracture
  259. 259. Another view
  260. 260. Photomic
  261. 261. Case #853.1 49 yr male with malignant hemangiopericytoma mid femur
  262. 262. Case #854 39 year female with benign hemangiopericytoma rib 3 years apart
  263. 263. Case #85529 year femalemalignanthemangiopericytomathoracic spine
  264. 264. Laminogram cut
  265. 265. CT scan
  266. 266. Lipid Bone Tumors
  267. 267. Parosteal Lipoma
  268. 268. Parosteal Lipoma Lipid tumors of bone, unlike soft tissue fatty tumors, are extremelyrare clinical entities. The most common of these rare tumors is theparosteal lipoma that is usually found lying on the surface of themetaphyseal portion of a long bone such as the humerus, femur ortibia. They usually occur in middle-aged patients with no sexdominance. Radiographically these lesions stand out because ofan exophytic bony spur arising from the surface of the metaphysealbone similar to the appearance of a small osteochondroma or bonespur, or in larger cases they can take on the appearance of a parostealsarcoma. However, the diagnostic feature of the parosteal lipomais the presence of a radiolucent cap of benign fatty tissue surroundingthe bone spur that extends out into the soft tissue a distance of 3-5cm. These lesions are very benign, are usually asymptomatic and donot require surgical treatment, similar to the situation with a softtissue lipoma.
  269. 269. CLASSICCase #16364 year femaleparosteal lipomadistal humerus spur
  270. 270. Axial T-1 MRI
  271. 271. Axial T-2 MRI
  272. 272. Case #163.1 AP & lat x-ray of a parosteal lipoma distal femur in A 67 yr male showing diagnostic bony spur at base
  273. 273. spurCoronal and axial T-1 MRI
  274. 274. Axial T-2 FS MRI Axial Gad
  275. 275. Case #16416 year femaleparosteal lipoma spurmid femur
  276. 276. Bone scan
  277. 277. spurAxial CT scan
  278. 278. Case #165 spur 25 year female with parosteal lipoma 5th metacarpal
  279. 279. Case #85929 year female spurparosteal lipomaproximal humerus
  280. 280. spurAxial T-1 MRI
  281. 281. spurCoronal T-1 MRI
  282. 282. Case #860 spur 74 year female with parosteal lipoma prox humerus
  283. 283. Intramedullary Lipoma
  284. 284. Intramedullary Lipoma Intramedullary lipomas are extremely rare conditions with approx-imately 30 cases in the world literature. They are usually locatedin the central area of the diaphysis of a long bone such as the femur,tibia, or fibula. For some reason, a large 30% of cases of this raretumor are seen in the os calcis. These lesions are usually asympto-matic and picked up as an incidental finding. They take on theradiographic appearance of fibrous dysplasia of a long bonebecause of slight fusiform dilatation of the surrounding cortex,which is slightly thinned out and in the central area there is evidenceof degenerative calcification and occasionally even bone formationin the lipoma. However, a T-1 weighted MRI image will show thehigh signal features of a lipoma to help differentiate the tumor fromfibrous dysplasia that has a low signal on a T-1 weighted image.These lesions are asymptomatic and do not require surgical treatment.There is no threat to the patient of pathologic fracture.
  285. 285. CLASSIC Case #16640 year femaleintramedullary lipomahumerus
  286. 286. Coronal T-1 MRI
  287. 287. Intramedullary lipoma Case #166.131 year male withpainless lytic lesionin proximal humerus
  288. 288. CT scan
  289. 289. Cor T-1 T-2 Gad
  290. 290. Axial T-2 Gad
  291. 291. Sag T-2 Gad
  292. 292. Case #166.2 Intramedullary lipoma 45 year male with incidental finding in right shoulder
  293. 293. Sag T-1 T-2Gad
  294. 294. Axial T-1 T-2 Gad
  295. 295. Case #166.2 Bone and soft tissue lipomaCT scan of a 54 year old femalewith a painless mass in axilla forone year
  296. 296. 3D CT scan recon
  297. 297. Sag T-1 Gad
  298. 298. Axial T-1 T-2 Gad
  299. 299. Case #166.3 Combined bone and soft tissue lipoma 69 year female with incidental findings in thigh and femur
  300. 300. Cor T-1 Gad
  301. 301. Axial T-1 T-1 Gad Gad
  302. 302. Case #167 CT scan53 year male withossifying lipomaos calcis
  303. 303. Another CT scan
  304. 304. Case #167.1 Cystic lipoma 31 year old male with incidental finding in foot
  305. 305. Sag T-1 T-2 Gad
  306. 306. Axial T-1 T-2 Gad
  307. 307. Cor T-1 Gad
  308. 308. Case #167.2 Lipoma 50 year male with mild heal pain for 1 year
  309. 309. Sag T-1 STIR Gad
  310. 310. Case #16850 year femaleossifying lipomadistal femur
  311. 311. Case #168.1 Intramedullary lipoma 31 year male with incidental finding in distal femur
  312. 312. Cor T-1 T-2 FS
  313. 313. Axial T-1 T-2 FS
  314. 314. Sag T-1 T-2 FS
  315. 315. Case #860.1 33 year female with intramedullary lipoma prox tibia
  316. 316. Coronal T-1 MRI
  317. 317. Axial T-1 MRI
  318. 318. Case #860.2 24 year male with intramedullary lipoma os calcis
  319. 319. Sagittal T-1 MRI
  320. 320. Coronal T-1 MRI
  321. 321. Case #860.3 Sagittal CT scan 55 year female with intracortical lipoma
  322. 322. Coronal T-1 MRI

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