summary Hemangioma of Soft Tissue is a benign vascular neoplasm that may be located in a cutaneous, subcutaneous, or intramuscular location. The condition is typically seen in patients < 30 years of age who present with a painful mass of variable size depending on activity level. Diagnosis is made with MRI with contrast. Treatment is usually a trial of observation, NSAIDs, vascular stockings, and activity modification. Embolization, sclerotherapy, or surgical resection are indicated for lesions associated with persistent symptoms not responsive to nonoperative management. Epidemiology Incidence males and females incidence is equal <1% of all benign vascular tumors Demographics more common in patients <30 years of age Anatomic location intramuscular is commonly found deep in the lower extremities most commonly found as isolated lesions, except for diffuse hemangioma, a rare childhood form which extensively involves a single limb common in the hand Etiology Types may be cutaneous, subcutaneous, or intramuscular capillary (superficial) or cavernous (deep) Pathophysiology caused by an error in the new formation of a segment of the vascular system hormones may play role in modulation 20% are associated with trauma Presentation Symptoms pain of variable intensity depending on activity level symptoms of vascular engorgement if hemangioma is large aching heaviness swelling Physical exam examine patient in both supine and standing position lower extremity lesions will fill up after several minutes of standing inspection mass of variable size depending on activity level Imaging Radiograph may show small phleboliths (calcifications) inside the lesion erosion into adjacent bone MRI with gadolinium differentiates these benign lesions from arteriovenous malformations and angiosarcomas increased signal on T1- and T2- weighted images focal areas of low-signal are a sign of blood flow or calcifications heterogeneous lesion with numerous small blood vessels and fatty infiltration (bag of worms) Studies Histology gross varies depending on whether it is capillary type or cavernous type color spectrum varies from red to tan to yellow micro no malignant cells noted by cellular pleomorphism noted many vascular dilations with large nuclei filled with erythrocytes vascular lumens infiltrated with muscle fibers (intramuscular type) cavernous shows large vessels with lots of fatty tissue Differential Other vascular malformations arteriovenous malformations cavernous hemangiomas angiomatosis vascular ectasia Sarcoma important to distinguish from sarcoma Treatment Nonoperative observation, NSAIDS, vascular stockings, and activity modification indications first line of treatment childhood lesions sclerotherapy or embolization performed by interventional radiology (IR) indications large, painful lesions that fail NSAID and vascular stockings therapy Operative marginal excision indications small lesions of the hand wide surgical resection indications lesions resistant to nonoperative management outcomes high incidence of local recurrence Complications Kasabach-Merritt syndrome rare complications caused by entrapped platelets leading to a possbly fatal coagulopathy Prognosis Infantile hemangiomas involute by age 7 No incidence of malignant transformation
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next (OBQ19.19) A 29-year old male patient presents to your clinic after 3 months of medial left knee pain that is worse when standing for a long period of time and after his weekly workgroup kickball games. Initially, he thought it was arthritis in his knee, but there is associated swelling on the inside of his knee that made him concerned. He denies any neurologic symptoms or unexplained weight loss. Figures A are X-rays and select MRI cuts performed in your clinic. Figure B is a biopsy specimen. What is the tissue of origin for this lesion? QID: 213921 FIGURES: A B Type & Select Correct Answer 1 Cartilage 17% (188/1130) 2 Bone 9% (107/1130) 3 Vascular 56% (631/1130) 4 Smooth Muscle 5% (54/1130) 5 Skeletal Muscle 12% (139/1130) L 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ17.197) A 17-year-old female presents to your office with a mass on her calf that has been present for 3 years. It does not cause pain and has not been growing in size overall but does enlarge towards the end of the day. Physical examination demonstrates a 2cm non-tender mass near the Achilles tendon without skin discoloration. The patient has a normal neurovascular examination of the extremity, and no other masses are found elsewhere. Advanced imaging is shown in Figures A-C. A biopsy was previously performed by an outside surgeon. What does the biopsy most likely demonstrate and what is the best treatment at this time? QID: 210284 FIGURES: A B C D Type & Select Correct Answer 1 Spindle cells in a wavy arrangement with positive S100 staining, wide resection and radiation 11% (186/1745) 2 Vascular dilations with erythrocytes and some striated muscle cells, observation 50% (876/1745) 3 Small round monotonous blue cells in pseudo-rosettes, chemotherapy followed by marginal excision 2% (43/1745) 4 Angiofibroblastic hyperplasia with disorganized collagen, observation 26% (457/1745) 5 Hemosiderin stained multinucleated giant cells, marginal excision 10% (166/1745) L 4 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ06.119) A 17-year-old male presents to your office with hand swelling and intermittent pain. His pain occurs when his hand is held in a dependent position or when he is swimming. While he was born with a birthmark on his hand, he has noticed it is progressively getting bigger. Clinical photograph, radiographs, and histology are shown. What is the most likely diagnosis? QID: 305 FIGURES: A B C D Type & Select Correct Answer 1 Synovial sarcoma 1% (21/3241) 2 Epitheliod sarcoma 5% (169/3241) 3 Angiosarcoma 19% (629/3241) 4 Benign hemangioma 74% (2387/3241) 5 Giant cell tumor of tendon sheath 1% (25/3241) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ04.13) A 30-year-old female presents with a painful posterior knee mass. The mass gets larger and more painful with activity. Examination reveals a boggy soft tissue mass about her knee. Radiograph and MRI are shown in Figures A and B. What is the most likely diagnosis? QID: 124 FIGURES: A B Type & Select Correct Answer 1 Synovial sarcoma 21% (422/2043) 2 Hemangioma 55% (1128/2043) 3 Lipoma 2% (42/2043) 4 Parosteal osteosarcoma 2% (37/2043) 5 Pigmented villonodular synovitis (PVNS) 20% (405/2043) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (0) Podcasts (1) Pathology⎪Hemangioma of Soft Tissue Orthobullets Team Pathology - Hemangioma of Soft Tissue Listen Now 12:10 min 6/16/2020 109 plays 0.0 (0)