Solitary skeletal hemangioma of the extremities

Objective. To report the clinicopathologic features of solitary skeletal he mangioma of the extremities and to review previous cases in the English lan guage medical literature. Patients. In addition to five of our own cases, 3 4 literature cases with substantial and 75 with partial clinicopathologic i nformation were found. Results. Our patients, three men and two women, rang ed in age from 37 to 83 years (mean 65.6 years). The lesion was an incident al radiologic finding in two patients, while three were symptomatic. in no case was a correct preoperative radiologic diagnosis made, a malignant proc ess being considered as a possibility in all. The hemangiomas were medullar y; two involved a metacarpal, two the fibula, and one the humerus. In contr ast, previously reported patients were younger (mean age 32 years), predomi nantly female (60%), and symptomatic in over 90% of cases. The lesion is ra re in those younger than age 10 years or older than age 60 years. As in our patients, the long bones are most frequently involved (75%), with the diap hysis or metadiaphysis. as in four of our patients, the most common locatio ns. Although 20% of cases occur in the hands or feet, metacarpal involvemen t is rare. Medullary origin, as in all of our cases, is most frequent, but 45% of cases are either periosteal (33%) or intracortical (12%). In the lit erature, cavernous hemangioma is the most frequent type. Three of our heman giomas were cavernous, one capillary, and one venous, the latter being rare ly reported in extremity bones. Conclusions. Due to the diversity of radiol ogic patterns produced by skeletal hemangioma, a correct preoperative diagn osis is rarely made. Almost all patients do well, even those with less than complete removal of the lesion; local recurrence is rare. AU of our patien ts were well following either therapeutic or simple diagnostic procedures. Due to the destructive nature of some biopsy procedures, the histologic dia gnosis of hemangioma may at times also be problematic.