Surface-based hemangiomas of bone. A review of 11 cases.

The surface-based hemangioma of bone is an uncommon cause of periosteal- or cortical-based lesions. The files of the Armed Forces Institute of Pathology were searched for lesions diagnosed as cortical hemangioma or periosteal hemangioma received between the years 1950 and 1990; 11 cases with follow-up results were identified. The 11 patients ranged in age from 11 to 31 years of age at the time of initial symptoms (average, 21 years; mean, 23 years). Sixty percent of the patients were male and 40% were female. Skeletal sites of involvement included the tibia (45%), the fibula (36%), the femur (9%), and the ulna (9%). Seventy percent of patients complained initially of pain (duration, two months to five years), whereas 30% reported pain and a mass at the time of initial diagnosis (duration, six months to two years). On plain film radiographs, eight lesions showed localized cortical thickening, two showed cortical erosion, and one had a permeative/destructive pattern. Bone scans showed solitary lesions with increased uptake in all 11 patients. The range of histologic types of cortical hemangioma included cavernous (six cases), arteriovenous (three cases), venous (one case), and pyogenic granuloma type (one case). Clinically, the majority of cases were diagnosed as osteoid osteomas; primary pathologic diagnoses included hemangioma (27%) and cortical sclerosis (18%). Persistent complaints were reported in three patients after intralesional biopsy; no recurrences were reported after en bloc excision.