Daoud Alexander, Olivieri Brandon, Feinberg Daniel, Betancourt Michel, Bockelman Brian
Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA,
Skeletal Radiol. 2015 Apr;44(4):597-603. doi: 10.1007/s00256-014-2017-0. Epub 2014 Sep 30.
Soft tissue hemangiomas are commonly encountered lesions, accounting for 7-10 % of all benign soft tissue masses (Mitsionis et al. J Foot Ankle Surg 16(2):27-9, 2010). While the literature describes the great majority of hemangiomas as asymptomatic and discovered only as incidental findings, they do have the potential to induce reactive changes in neighboring structures (Pastushyn et al. Surg Neurol 50(6):535-47, 1998). When these variants occur in close proximity to bone, they may elicit a number of well-documented reactive changes in osseous tissue (Mitsionis et al. J Foot Ankle Surg 16(2):27-9, 2010; DeFilippo et al. Skelet Radiol 25(2):174-7, 1996; Ly et al. AJR Am J Roentgenol 180(6):1695-700, 2003; Sung et al. Skelet Radiol 27(4):205-10, 1998). However, instances of direct extension into bone by soft tissue hemangiomas--that is, infiltration of the mass's vascular components into nearby osseous tissue--are currently undocumented in the literature. In these cases, imaging plays an important role in differentiating hemangiomas from malignant lesions (Mitsionis et al. J Foot Ankle Surg 16(2):27-9, 2010; Sung et al. Skelet Radiol 27(4):205-10, 1998; Pourbagher, Br J Radiol 84(1008):1100-8, 2011). In this article, we present such a case that involved the sacral spine. Imaging revealed a soft tissue mass with direct extension of vascular components into osseous tissue of the adjacent sacral vertebrae. Biopsy and subsequent histopathologic examination led to definitive diagnosis of soft tissue hemangioma. While MRI is widely regarded as the gold standard imaging modality for evaluating hemangiomas, in this report we describe how CT can aid in narrowing the differential diagnosis when one encounters a vascular lesion with adjacent osseous changes. Furthermore, we review the literature as it pertains to the imaging of soft tissue hemangiomas that occur in proximity to osseous tissue, as well as correlate this case to current theories on the pathogenesis of hemangiomas. Radiologists should be aware that benign soft tissue hemangiomas demonstrate a spectrum of imaging findings, including aggressive-appearing changes to adjacent bone.
软组织血管瘤是常见病变，占所有良性软组织肿块的7% - 10%（米齐奥尼斯等人，《足踝外科杂志》16(2):27 - 29，2010年）。虽然文献中描述的绝大多数血管瘤无症状，仅为偶然发现，但它们确实有可能引起邻近结构的反应性改变（帕斯托申等人，《神经外科学》50(6):535 - 547，1998年）。当这些病变紧邻骨骼发生时，它们可能在骨组织中引发一些有充分文献记载的反应性改变（米齐奥尼斯等人，《足踝外科杂志》16(2):27 - 29，2010年；德菲利波等人，《骨骼放射学》25(2):174 - 177，1996年；李等人，《美国放射学杂志》180(6):1695 - 1700，2003年；宋等人，《骨骼放射学》27(4):205 - 210，1998年）。然而，软组织血管瘤直接侵犯骨骼，即肿块的血管成分浸润到附近骨组织的情况，目前文献中尚无记载。在这些病例中，影像学在区分血管瘤与恶性病变方面起着重要作用（米齐奥尼斯等人，《足踝外科杂志》16(2):27 - 29，2010年；宋等人，《骨骼放射学》27(4):205 - 210，1998年；普尔巴赫尔，《英国放射学杂志》84(1008):1100 - 1108，2011年）。在本文中，我们报告了这样一例累及骶椎的病例。影像学检查发现一个软组织肿块，其血管成分直接延伸至相邻骶椎的骨组织。活检及随后的组织病理学检查确诊为软组织血管瘤。虽然磁共振成像（MRI）被广泛认为是评估血管瘤的金标准影像学检查方法，但在本报告中，我们描述了计算机断层扫描（CT）在遇到伴有相邻骨质改变的血管性病变时如何有助于缩小鉴别诊断范围。此外，我们回顾了与紧邻骨组织的软组织血管瘤影像学相关的文献，并将此病例与当前关于血管瘤发病机制的理论进行关联。放射科医生应意识到，良性软组织血管瘤表现出一系列影像学表现，包括对相邻骨骼看似侵袭性的改变。
