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Al Khaldi T, Verge R, Rouch A, Brouchet L. Treatment of left tenth rib haemangioma vascularised by a costal artery giving the artery of Adamkiewicz. BMJ Case Rep 2024; 17:e260257. [PMID: 39231560 DOI: 10.1136/bcr-2024-260257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
Haemangioma of the ribs is considered an extremely rare benign tumour. Here, we present a case of a young male with left tenth rib haemangioma vascularised by a costal artery giving the artery of Adamkiewicz presented as chronic cough. This was successfully treated through preoperative embolisation and surgical resection. A preoperative angiogram was performed to identify the origin of the artery of Adamkiewicz. The final diagnosis was confirmed histopathologically. There were no complications in the postoperative course and no recurrence during 12 months of follow-up.
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Affiliation(s)
- Turki Al Khaldi
- Department of Vascular Surgery, Bahrain Defence Force, Manama, Bahrain
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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 2024; 32:1154-1157. [PMID: 38062642 DOI: 10.1177/10668969231213984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Hemangioma of the Rib Mimicking Chondrosarcoma: A Report of Two Cases and Literature Review. Case Rep Orthop 2021; 2021:9996380. [PMID: 34621554 PMCID: PMC8492244 DOI: 10.1155/2021/9996380] [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: 03/14/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022] Open
Abstract
Cases Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision was performed with no surgical complication. Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone. Conclusion We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the en bloc excision without biopsy can be a practical treatment option.
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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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Woo CG, Lee HC, Son SM, Hong JM, Lee OJ. Clinicopathological characteristics of costal hemangiomas: a case report and literature review. J Int Med Res 2018; 47:982-985. [PMID: 30477380 PMCID: PMC6381469 DOI: 10.1177/0300060518809589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bone hemangioma accounts for approximately 1% of all bone neoplasms and commonly occurs in the vertebral body and skull. However, costal hemangiomas are extremely rare. We herein present a case involving a 52-year-old woman with a hemangioma in the third rib and review 29 cases of rib hemangiomas available in the literature. Rib hemangioma mainly affects women in their 50s and has expansile osteolytic features in radiographs and a weak maximum standardized uptake value in 18F-fluorodeoxyglucose positron emission tomography images. When these findings are displayed, clinicians should include rib hemangioma as a differential diagnosis and consider avoidance of preoperative biopsy because of the risk of life-threatening bleeding.
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Affiliation(s)
- Chang Gok Woo
- 1 Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Ho-Chang Lee
- 1 Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea.,2 Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Myoung Son
- 1 Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Jong-Myeon Hong
- 2 Chungbuk National University College of Medicine, Cheongju, Korea.,3 Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Ok-Jun Lee
- 1 Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea.,2 Chungbuk National University College of Medicine, Cheongju, Korea
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Arrigoni F, Bruno F, Zugaro L, Splendiani A, Di Cesare E, Barile A, Masciocchi C. Role of interventional radiology in the management of musculoskeletal soft-tissue lesions. Radiol Med 2018; 124:253-258. [PMID: 29687209 DOI: 10.1007/s11547-018-0893-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022]
Abstract
The lesions of the soft tissues are rare and extremely heterogeneous; even if the surgical treatment is usually the standard therapy, the role of the interventional radiology (IR) in this field is growing up for multiple reasons. First, because the imaging alone usually is not able to ensure a definitive diagnosis, IR has a basic role in the staging: the percutaneous biopsy is infact an irreplaceable step. Moreover, biopsy is necessary not only for histologic evaluations but also for the biochemical and molecular studies. Furthermore, the proved safety and effectiveness of IR in a multiple oncologial applications prompt a wider use also in this field.
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Affiliation(s)
- Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy.
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
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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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