Musculoskeletal angiosarcomas, (along with hemangiopericytomas and hemangioendotheliomas) are tumors that arise from vascular structures. They are typically difficult to distinguish from one another on imaging alone.
Angiosarcomas, are the most aggressive of the three, frequently having metastases at the time of diagnosis, and often having local recurrences.
They can occur in:
- skin: 33%
- soft tissues: 24%
angiosarcoma of bone: 6%
- long bones: 60%
- tibia: 23%
- femur: 18%
- humerus: 13%
- pelvis: 7%
- long bones: 60%
Histologically they can contain either hemangiomatous or lymphangiomatous cellular elements, which accounts for them previously being referred to as lymphangiosarcomas or haemangiosarcomas.
May be seen as a non-specific soft tissue mass. When involving bone, they are predominantly lytic, and may mimic hemangiomas with a course honeycomb appearance.
Dense, well-circumscribed areas of enhancement with early draining veins and shunting. Hemangiopericytomas are described as having a pedicle formed by the arteries supplying the tumor from which vessels branch to encircle the tumor.
Non-specific soft tissue mass, with a density similar to muscle but demonstrating bright contrast enhancement. CTA may demonstrate large feeding vessels.
Brightly enhancing soft tissue mass, often hyperintense on T2WI, with prominent flow voids, most marked in hemangiopericytomas.
- angiosarcoma (general article)
- 1. Murphey MD, Fairbairn KJ, Parman LM et-al. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation. Radiographics. 1995;15 (4): 893-917. Radiographics (abstract) - Pubmed citation
- 2. Choi JJ, Murphey MD. Angiomatous skeletal lesions. Semin Musculoskelet Radiol. 2000;4 (1): 103-12. - Pubmed citation
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The differential diagnosis for bone tumors is dependent on the age of the patient, with a very different set of differentials for the pediatric patient.
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- bizarre parosteal osteochondromatous proliferation (Nora lesion)
- chondromyxoid fibroma
- juxtacortical chondroma
- fibrous bone lesions
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- giant cell tumor of bone
- Gorham massive osteolysis
- haemophilic pseudotumor
- intradiploic epidermoid cyst
- intraosseous lipoma
- musculoskeletal angiosarcoma
- musculoskeletal hemangiopericytoma
- primary intraosseous hemangioma
- post-traumatic cystic bone lesion
- simple bone cyst
- impending fracture risk
- describing a bone lesion