Musculoskeletal angiosarcomas, (along with haemangiopericytomas and haemangioendotheliomas) are tumours 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 haemangiomatous 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 haemangiomas 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 tumour from which vessels branch to encircle the tumour.
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 haemangiopericytomas.
- 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
The differential diagnosis for bone tumours is dependent on the age of the patient, with a very different set of differentials for the paediatric patient.
- bone-forming tumours
- cartilage-forming tumours
- chondromyxoid fibroma
- fibrous bone lesions
- bone marrow tumours
- other bone tumours or tumour-like lesions
- aneurysmal bone cyst
- benign fibrous histiocytoma
- giant cell tumour of bone
- Gorham massive osteolysis
- haemophilic pseudotumour
- intradiploic epidermoid cyst
- intraosseous lipoma
- musculoskeletal angiosarcoma
- musculoskeletal haemangiopericytoma
- primary intraosseous haemangioma
- simple bone cyst
- impending fracture risk