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IMAGE QUIZ ARCHIVE
Image Quiz
A Painful Mass on the Anterior Surface of the Tibia1
(continued)
Answer: Intracortical hemangioma of bone
For larger view, click on image

Fig. 1-A
Fig. 1-B
Fig. 1-C
Fig. 1-A. Plain lateral radiograph showing an ovoid intracortical lytic lesion with internal calcification of the trabeculae in a vertical alignment. Fig. 1-B. Axial computed tomographic section, 1-mm thick, showing an ovoid lesion of low attenuation with so-called intralesional wire-netting calcification. Fig. 1-C. T2-weighted magnetic resonance image revealing an intracortical area of high signal intensity, with internal, hypointense septa.

Fig. 1-D
Fig. 1-E		  
Figs. 1-D and 1-E. Photomicrographs of specimens from the intracortical hemangioma, cut longitudinally. Fig. 1-D. Detail of a dilated cavernous vessel with a thin wall and an endothelial lining (×200). Fig. 1-E. General structure of the lesion. The vascular growth of the tumor conferred a trabecular appearance on the cortical compact bone (×64).
Discussion
Hemangioma of bone is an osseous neoplasm accounting for less than 1% of bone tumors (eighty of 8542)2. Biopsies are rarely done. Dorfman et al. found that seventeen (71%) of twenty-four hemangiomas occurred in the bodies of the vertebrae and in the skull3. Lesions in the spine have a coarse, vertical trabecular pattern with a so-called corduroy appearance on radiographs4. A computed tomographic scan displays a characteristic polka-dot pattern4,5. Radiographically, cranial hemangiomas have the appearance of cortical expansion with a radiating trabecular pattern, or the so-called sunburst sign4,5. Lesions in the long bones, which are much less frequent, generally affect the medullary cavity of the metaphysis and provoke a bubbly lysis of bone or a coarsely lobulated appearance4.
References

1. López-Barea F, Hardisson D, Rodriguez-Peralto JL, Sanchez-Herrera S, Lamas M. Intracortical hemangioma of bone. Report of two cases and review of the literature. J Bone Joint Surg Am. 1998;80:1673-8.
2. Dahlin DC, Unni KK. Introduction and scope of the study. In: Dahlin DC, Unni KK, editors. Bone tumors. General aspects and data on 8,542 cases. Springfield, Illinois: Charles C. Thomas; 1986. p 3-17.
3. Dorfman HD, Steiner GC, Jaffe HL. Vascular tumors of bone. Hum Pathol. 1971;2:349-76.
4. Wold LE, Swee RG, Sim FH. Vascular lesions of bone. Pathol Annu 1985;20 Pt 2:101-37.
5. Murphey MD, Fairbairn KJ, Parman LM, Baxter KG, Parsa MB, Smith WS. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation. Radiographics. 1995;15:893-917.
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