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Tan GZL, Leow L, Kuek BJW, Mok Y. Locally Aggressive Rib Hemangioma With Glomeruloid and Papillary Features - Expanding the Clinicopathologic spectrum of Bone Hemangiomas. Int J Surg Pathol 2023:10668969231213984. [PMID: 38062642 DOI: 10.1177/10668969231213984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Intra-osseous hemangiomas are uncommon tumors that can present diagnostic and treatment dilemmas. Bone hemangiomas with papillary and glomeruloid growth patterns are exceptionally rare. We present an example of an intra-osseous hemangioma of the rib displaying aggressive features on both radiology and histology. Morphologically, prominent papillary and glomeruloid architectural patterns were observed, in addition to features of cavernous and capillary hemangiomas. Extensive extra-osseous soft tissue involvement was seen. Awareness of the diverse histological features and locally aggressive behavior of bone hemangiomas is important in avoiding over-interpretation as a malignant lesion.
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Affiliation(s)
- Gideon Ze Lin Tan
- Department of Pathology, National University Health System, Singapore
| | - Lowell Leow
- Thoracic Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Benjamin Jia Wei Kuek
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Yingting Mok
- Department of Pathology, National University Health System, Singapore
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Liu S, Xiang L, Ding F, Yuan L, Wang XM. Case Report: Cavernous hemangioma of rib: an extremely rare venous malformation but easily misdiagnosed as aggressive tumors. Front Oncol 2023; 13:1164331. [PMID: 37350947 PMCID: PMC10282769 DOI: 10.3389/fonc.2023.1164331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
Hemangioma is a congenital vascular malformation that occurs commonly in the skin and soft tissues of younger individuals but rarely in the bone. The term hemangioma occurring in bone has been referred to as venous bony malformation also. In these rare cases, vertebral bodies occur more often, followed by the craniofacial skeleton and long bones. Most rib tumors are malignant, and hemangiomas of the rib tend to grow expansively and disrupt the cortex. Venous malformations in ribs are not tumors but can be misdiagnosed as aggressive tumors or infectious processes. In fact, hemangioma of bone is a locally aggressive benign vascular malformation associated with a good prognosis. To date, no more than 50 cases of rib hemangiomas have been described in the English literature. This report presents a case of an asymptomatic 27-year-old female patient who found a quail egg-sized lump on the right side of her chest that was the size of a cocoon 2 months prior. Then, the lump grew rapidly to the size of an egg when she presented to the hospital. Because of its worrisome histomorphologic features and aggressive clinical radiologic findings, it was once misdiagnosed as a malignant tumor by most doctors. However, the pathological results after the operation confirmed rib hemangioma. Therefore, this case report aims to share this particular case so that more doctors can better understand the particularity of this disease's progression.
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Affiliation(s)
- Shan Liu
- Department of Thoracic Surgery, The Third Hospital of Wuhan, Wuhan, China
| | - Luan Xiang
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, China
| | - Fan Ding
- Department of Orthopaedics, General Hospital of Central Theater Command of The People’s Liberation Army, Wuhan, China
| | - Ling Yuan
- Department of Pathology, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, China
| | - Xiu-Mei Wang
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, China
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Morkan DB, Gauthier JM, Kreisel D, Puri V, Nava RG. Incidentally found rib hemangioma: case report and discussion of management. AME Case Rep 2021; 5:13. [PMID: 33912802 DOI: 10.21037/acr-20-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/06/2021] [Indexed: 11/06/2022]
Abstract
Rib hemangioma is a rare chest wall tumor for which few reports in the literature exist to help guide treatment. The clinical presentation, radiographic findings, and treatment strategies vary in the literature, with the majority of patients undergoing surgical resection to definitively rule out malignancy. Here, we report a 23-year-old woman with an incidentally discovered rib hemangioma, who had a history of migraines, during the workup of a severe headache refractory to medical treatment. Imaging revealed a solitary, expansile tumor arising from the posterior left third rib. Spinal magnetic resonance imaging (MRI) showed a fat-containing lesion with multiple vascular flow voids, non-enhancement, and high signal intensity on the T2-weighted series. It appeared to have a honeycomb core on chest computed tomography (CT). Imaging characteristics of the lesion were consistent with an intraosseous hemangioma. The tumor was managed with upfront surgical resection without a preoperative biopsy. The case was uneventful and no complications were encountered. The patient recovered well, denied any symptoms four weeks after surgery, and a follow-up chest X-ray was unremarkable. Following resection, the pathological diagnosis was concordant with the radiographic diagnosis of a rib hemangioma. Here, we review existing literature on the rare case of a rib hemangioma with a focus on the radiographic characteristics and management. Given that radiographic features of this lesion were consistent with prior reports and surgery did not change the diagnosis, we suggest that non-operative management be considered for similar lesions, as surgical resection does not appear to reveal occult malignancy in the majority of cases.
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Affiliation(s)
- Deniz B Morkan
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jason M Gauthier
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Secondary Chondrosarcoma Presenting with Symptoms Similar to Thoracic Outlet Syndrome. Case Rep Orthop 2018; 2018:9347145. [PMID: 29721343 PMCID: PMC5867559 DOI: 10.1155/2018/9347145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/08/2018] [Indexed: 11/18/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is caused by heterogeneous factors that compress the brachial plexus and subclavian artery; tumor is rarely a cause of TOS. Here, we present the case of a 26-year-old man with secondary chondrosarcoma arising from osteochondroma of the left clavicle causing TOS, with a direct compression of the brachial plexus and subclavian artery. Immediately after surgery, the symptoms of TOS reduced. To our knowledge, this is the first case of a secondary chondrosarcoma of the clavicle causing TOS, which is possibly the key symptom for diagnosing malignant transformation of osteochondroma of the clavicle.
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Itabashi T, Emori M, Terashima Y, Hasegawa T, Shimizu J, Nagoya S, Yamashita T. Hemangioma of the rib showing a relatively high 18F-FDG uptake: a case report with a literature review. Acta Radiol Open 2017; 6:2058460117728416. [PMID: 28959457 PMCID: PMC5593230 DOI: 10.1177/2058460117728416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/31/2017] [Indexed: 01/05/2023] Open
Abstract
Hemangioma of the rib is a rare benign tumor that is often difficult to distinguish from malignant bone tumors. Rib hemangioma often shows bony disruption with a slight cortical disruption, extraosseous lesion, and expanded bone on computed tomography (CT). We report the case of a 68-year-old man with atypical rib hemangioma with a slight cortical disruption and no expanded bone. The tumor showed relatively high 18FDG-uptake on positron emission tomography (PET)/CT. Rib hemangioma often shows higher 18FDG-uptake. PET/CT may not provide useful information for distinguishing rib hemangioma from a malignant tumor. Close observation without surgical resection may be feasible if the tumor is diagnosed as a rib hemangioma by biopsy.
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Affiliation(s)
| | - Makoto Emori
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | | | - Junya Shimizu
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Nagoya
- Sapporo Medical University School of Medicine, Sapporo, Japan
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Deshmukh H, Rathod KK, Hira P, Sankhe S, Pandit N, Mittal K, Dey AK. Hemangioma of rib: a different perspective. Pol J Radiol 2015; 80:172-5. [PMID: 25866595 PMCID: PMC4386590 DOI: 10.12659/pjr.893011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/19/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hemangiomas are one of the common primary benign tumors of the intraosseous and soft tissue compartments in humans. Vertebral hemangiomas being the most common of all are seen in daily radiological practice. Hemangioma of the rib is rarely seen. CASE REPORT We reported on a case of a rib lesion which had a classic imaging pattern of hemangioma. We highlighted the use of pre-operative embolization of such a vascular rib lesion before surgically removing the lesion by thoracotomy to reduce the risk of bleeding. CONCLUSIONS We also emphasized overt complications of overzealous needling of such a vascular lesion for histopathological diagnosis as in our case.
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Affiliation(s)
- Hemant Deshmukh
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kranti K Rathod
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Priya Hira
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shilpa Sankhe
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nilesh Pandit
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kartik Mittal
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Amit K Dey
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Rib hemangioma: uncommon benign vascular tumor. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mlika M, Ayadi-Kaddour A, Racil H, Marghli A, Chabbou A, Kilani T, El Mezni F. [A case of costal haemangioma]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:359-362. [PMID: 22137280 DOI: 10.1016/j.pneumo.2010.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/26/2010] [Accepted: 11/14/2010] [Indexed: 05/31/2023]
Abstract
UNLABELLED Costal primary tumors are rare and dominated by malignant tumors. Haemangioma of the bone represents only 1% of bone tumors. Costal localization accounts only for 1% of the cases and only about fifty cases have been reported in the literature. AIM The authors aim to describe a rare costal tumor, its histological features and the main differential diagnoses. OBSERVATION The authors describe the case of a 46-year-old woman who presented with chest pain. Radiological findings did not permit a malignant tumor to be ruled out and the treatment consisted of a resection of the posterior arch of the rib. Microscopic examination concluded that the patient had a costal haemangioma and the patient didn't present any recurrence after a six-year follow-up. CONCLUSION The costal haemangioma is a very rare tumor with a debated etiology. Some radiological features are specific such as the "soap bubble" or "honeycomb" aspect. However, the basis for diagnosis remains microscopic examination. These tumors have a good prognosis and no cases of recurrence have been reported following complete resection.
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Affiliation(s)
- M Mlika
- Département de pathologie, hôpital Abderrahman Mami, Tunis, Tunisie.
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Figueroa Almánzar S, Artigues Rojas I, Martínez Hernández N. [Superior thoracic outlet syndrome caused by a subclavian paraganglioma]. Arch Bronconeumol 2010; 46:611-2. [PMID: 20870336 DOI: 10.1016/j.arbres.2010.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/22/2010] [Accepted: 07/27/2010] [Indexed: 11/17/2022]
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Boezaart AP, Haller A, Laduzenski S, Koyyalamudi VB, Ihnatsenka B, Wright T. Neurogenic thoracic outlet syndrome: A case report and review of the literature. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2010; 4:27-35. [PMID: 21072145 PMCID: PMC2966747 DOI: 10.4103/0973-6042.70817] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neurogenic thoracic outlet syndrome (NTOS) is an oft-overlooked and obscure cause of shoulder pain, which regularly presents to the office of shoulder surgeons and pain specialist. With this paper we present an otherwise healthy young female patient with typical NTOS. She first received repeated conservative treatments with 60 units of botulinium toxin injected into the anterior scalene muscle at three-month intervals, which providing excellent results of symptom-free periods. Later a trans-axillary first rib resection provided semi-permanent relief. The patient was followed for 10 years after which time the symptoms reappeared. We review the literature and elaborate on the anatomy, sonoanatomy, etiology and characteristics, symptoms, diagnostic criteria and treatment modalities of NTOS. Patients with NTOS often get operated upon - even if just a diagnostic arthroscopy, and an interscalene or other brachial plexus block may be performed. This might put the patient in jeopardy of permanent nerve injury, and the purpose of this review is to minimize or prevent this.
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Affiliation(s)
- André P Boezaart
- Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
| | - Allison Haller
- Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
| | - Sarah Laduzenski
- Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
| | - Veerandra B. Koyyalamudi
- Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
| | - Barys Ihnatsenka
- Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
| | - Thomas Wright
- Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists
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Abstract
First rib pathology can narrow the thoracic outlet thus producing compression of the brachial plexus and subclavian vessels. There have been only three case reports of neurogenic thoracic outlet syndrome (TOS) caused by a nonunion of the first rib and there have been no reports of a first rib malunion causing TOS. A rare case of TOS caused by a malunion of the first rib is presented.
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Affiliation(s)
- Ethan R Wiesler
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
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Nakamura H, Kawasaki N, Taguchi M, Kitamura H. Cavernous hemangioma of the rib diagnosed preoperatively by percutaneous needle biopsy. Gen Thorac Cardiovasc Surg 2007; 55:134-7. [PMID: 17447513 DOI: 10.1007/s11748-006-0086-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 74-year-old man presented to our hospital with persistent low-grade back pain that had continued for 6 months. An expansile tumor containing delicate bony trabeculae was found in the posterior portion of the left fifth rib. Preoperative examination of a percutaneous needle biopsy specimen suggested a diagnosis of hemangioma; postoperative pathology examination of the resected tumor confirmed this diagnosis. We emphasize the value of preoperative needle biopsy in determining the most suitable treatment for these rib tumors.
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Affiliation(s)
- Haruhiko Nakamura
- Department of Chest Surgery, Atami Hospital, International University of Health and Welfare, 13-1 Higashikaigan-cho, Atami, Shizuoka, Japan.
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Abstract
The anatomic problems that lead to TOS are now well known. They consist of congenital anomalies that are superimposed on some form of trauma. There are some promising technologies that offer hope of early anatomic diagnosis. Sophisticated imaging of the brachial plexus as advocated by Collins offers hope. High resolution multidetector CT scanning seems even more promising.
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Affiliation(s)
- Charles O Brantigan
- Department of Surgery, Presbyterian St. Lukes Medical Center, Historic Gebhard Mansion, 2253 Downing Street, Denver, CO 80205, USA.
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