Bone & joints
Vascular tumors
Hemangioma
Author: Nat Pernick, M.D.
Last author update: 1 June 2005
Last staff update: 6 November 2024 (update in progress)
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed search: hemangioma [title] bone
Table of Contents
Definition / general | Radiology description | Gross description | Microscopic (histologic) description | Differential diagnosis | Epithelioid hemangiomaCite this page: Pernick N. Hemangioma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bonehemangioma.html. Accessed November 27th, 2024.
Definition / general
- Most common vascular tumor of bone
- Identified in vertebrae in 12% of autopsies, 34% are multiple
- Usually incidental finding; ages 20 - 50 years, no definite gender preference
- May actually be vascular malformations, not neoplasms
- Multiple bony hemangiomas more common in children, associated with cutaneous, soft tissue or visceral hemangiomas
- Sacral hemangiomas in infants associated with congenital anomalies
- Sites for clinically significant hemangiomas: skull, vertebrae (causing spinal cord compression), jaw; occur in marrow
Radiology description
- Sunburst appearance due to trabecular bone, particularly in spine and skull
- Nonspecific in long bones
Gross description
- Elevation of periosteum
- Currant jelly cut surface
Microscopic (histologic) description
- Thick walled lattice-like pattern of vessels
- Either capillary or cavernous
- Often with reactive new bone formation
- No endothelial atypia
Differential diagnosis
Epithelioid hemangioma
Definition / general
Radiology description
Treatment
Gross description
Microscopic (histologic) description
Positive stains
Differential diagnosis
Additional references
- Rare; usually affects long tubular and flat bones but may occur in any bone
- Also occurs in skin and subcutis
- Mean age 34 - 46 years, range teens to 70s
- 25% multifocal
Radiology description
- Lytic or blastic, well defined or poorly circumscribed margins
Treatment
- Curettage, excellent prognosis
Gross description
- 2 - 15 cm
- Well circumscribed, soft, dark red, limited to medullary cavity
Microscopic (histologic) description
- Replaces marrow, surrounds bony trabeculae, erodes cortex, may have soft tissue component
- Lobular growth pattern
- Epithelioid cells line well formed vessels, but may also grow in sheets and cords; nuclei are grooved, vesicular, may have prominent nucleoli
- No severe nuclear atypia
- Abundant eosinophilic cytoplasm, often with vacuoles
- < 5 mitotic figures/10 high power fields
- Stroma is loose connective tissue with lymphocytes, eosinophils, extravasated red blood cells
Positive stains
- EMA, factor VIII related antigen, Ulex europaeus
- Variable CD31, CD34, keratin
Differential diagnosis
Additional references
