Bone & joints

Vascular tumors


Last author update: 1 June 2005
Last staff update: 17 January 2022

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PubMed search: hemangioma [title] bone

Nat Pernick, M.D.
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Cite this page: Pernick N. Hemangioma. website. Accessed November 28th, 2023.
Definition / general
  • Most common vascular tumor of bone
  • Identified in vertebrae in 12% of autopsies, 34% are multiple
  • Usually incidental finding; ages 20 - 50 years, no definite gender preference
  • May actually be vascular malformations, not neoplasms
  • Multiple bony hemangiomas more common in children, associated with cutaneous, soft tissue or visceral hemangiomas
  • Sacral hemangiomas in infants associated with congenital anomalies
  • Sites for clinically significant hemangiomas: skull, vertebrae (causing spinal cord compression), jaw; occur in marrow
Radiology description
  • Sunburst appearance due to trabecular bone, particularly in spine and skull
  • Nonspecific in long bones
Gross description
  • Elevation of periosteum
  • Currant jelly cut surface
Microscopic (histologic) description
  • Thick walled lattice-like pattern of vessels
  • Either capillary or cavernous
  • Often with reactive new bone formation
  • No endothelial atypia
Differential diagnosis
Epithelioid hemangioma
Definition / general
  • Rare; usually affects long tubular and flat bones but may occur in any bone
  • Also occurs in skin and subcutis
  • Mean age 34 - 46 years, range teens to 70s
  • 25% multifocal

Radiology description
  • Lytic or blastic, well defined or poorly circumscribed margins

  • Curettage, excellent prognosis

Gross description
  • 2 - 15 cm
  • Well circumscribed, soft, dark red, limited to medullary cavity

Microscopic (histologic) description
  • Replaces marrow, surrounds bony trabeculae, erodes cortex, may have soft tissue component
  • Lobular growth pattern
  • Epithelioid cells line well formed vessels, but may also grow in sheets and cords; nuclei are grooved, vesicular, may have prominent nucleoli
  • No severe nuclear atypia
  • Abundant eosinophilic cytoplasm, often with vacuoles
  • < 5 mitotic figures/10 high power fields
  • Stroma is loose connective tissue with lymphocytes, eosinophils, extravasated red blood cells

Positive stains
Differential diagnosis
Additional references
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