Angiosarcoma (bone)

Angiosarcoma of bone is a malignant vascular tumour of bone. These are rare and account for less than 1% of malignant bone tumours. The majority of these tumours arising in bone are primary; however, a tiny percentage is either radiation-induced or associated with bone infarction

Epidemiology

Most common in young individuals. Males are more commonly affected than females. 

Clinical features

Although there is no particular clinical presentation, the majority of the patients present with a chronic dull pain and/or tumour mass. Other presentations include

• associated neurological deficits
• pathological fractures - rare

Pathology

Location - distribution

• most common sites are short and long tubular bones of extremities ²
  • femur - 23%
  • tibia - 18%
  • humerus - 13%
  • pelvis - 7%

Patterns of involvement 

Angiosarcomas can be unifocal or multifocal (up to a 3^rd can be multifocal ⁴)

Radiographic features 

Plain radiograph

They are usually purely lytic, eccentric and occur in a metadiaphyseal location. They can have a very aggressive appearance, without a periosteal reaction  andand less soft tissue extension. 

Can occur as multiple lesions in same bone. 

Metastatic lesions to other skeletal sites may be seen.

Treatment and prognosis

In general very poor prognosis and depends on location and extent. Treatment options include:

• wide surgical excision 
• limb-sparing surgery
• radiotherapy

Differential diagnosis

Possible differential considerations include:

• metastatic carcinoma to bone
• other malignant vascular tumours of bone -
  • haemangiopericytoma of bone - not possible to differentiate radiologically ²
  • haemangioendothelioma of bone - not possible to differentiate radiologically ²

See also

• angiosarcoma
  • musculoskeletal angiosarcoma