Musculoskeletal Angiomatous Lesions

Radiologic-Pathologic Correlation

Abstract Introduction Hemangioma Lymphangioma

Glomus Tumor Angiomatosis Angiomatous Syndromes and Associated Conditions Hamangioendothelioma, Hemangiopericytoma, and Angiosarcoma

Biopsy, Treatment, and Prognosis Summary Source Information References

Biopsy, Treatment, and Prognosis

Establishing a diagnosis of either osseous or soft-tissue angiomatous lesions by means of percutaneous fine-needle aspiration biopsy has not been very successful, in our experience. The failure is likely related to bleeding and lack of adequate solid tissue for histologic diagnosis, particularly in less aggressive vascular lesions such as cavernous hemangioma. In addition, extensive bleeding with death by exsanguination has been reported during biopsy of musculoskeletal angiomatous lesions (5).

Hemangioma and lymphangioma are usually treated by surgical resection or laser therapy (33). In addition, embolization or sclerotherapy may be used to precede definitive surgical resection to lessen blood loss or for unresectable lesions as the only reasonable therapy short of amputation. Radiologists, therefore, may become involved in the treatment of angiomatous lesions. Embolization is often performed with a mixture of polyvinyl alcohol particles (Ivalon; Biodyne, El Cajon, Calif), 200 300 or 300 500 ¾m in diameter, and the sclerosing agent sodium tetradecyl sulfate (Sotradecol 3%; Elkins-Sinn, Cherry Hill, NJ) (Figure 4, Figure 11) (84). Multiple episodes of embolization or sclerotherapy may be necessary. Radiation therapy is also an alternative treatment for lesions that are unresectable, either because of size or location (eg, symptomatic spinal angiomas). Recurrence of soft-tissue hemangiomas is seen in 28% of cases (25).

The aggressive vascular neoplasms hemangioendothelioma, hemangiopericytoma, and angiosarcoma are usually treated surgically. Patients with malignant vascular tumors also receive additional radiation therapy and chemotherapy. Less aggressive hemangioendotheliomas and hemangiopericytomas have a generally favorable prognosis, with local recurrence being less common and metastases unusual. In more aggressive malignant vascular tumors, however, local recurrence is frequent and prognosis is notoriously poor, with early metastases commonly developing in the lungs, bone, and lymph nodes (78).

Abstract Introduction Hemangioma Lymphangioma

Glomus Tumor Angiomatosis Angiomatous Syndromes and Associated Conditions Hamangioendothelioma, Hemangiopericytoma, and Angiosarcoma

Biopsy, Treatment, and Prognosis Summary Source Information References