Asian Cardiovasc Thorac Ann 2008;16:e25-e27
© 2008 Asia Publishing EXchange Ltd
Cavernous Hemangioma of The Rib: A Case Report
Kadri Ceberut, MD,
Ya
ar Metin Aksoy, MD1,
Fikriye Sava, MD2,
Ahmet Müslehiddino
lu, MD3
Department of Thoracic Surgery
1 Department of Cardiovascular Surgery
2 Department of Radiology
3 Department of Pathology, Tokat State Hospital, Tokat, Turkey
For reprint information contact: Kadri Ceberut, MD Tel: 90 356 214 5400 Fax: 90 356 214 5446 Email: kadri.ceberut{at}isbank.net.tr, Department of Thoracic Surgery, Tokat Devlet Hastanesi, Gö üs Cerrahisi, 60100 Tokat, Turkey.
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ABSTRACT
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Cavernous hemangioma of the bone is an uncommon benign vascular tumor, generally occurring in the spine or skull but extremely rare in the rib. We report the case cavernous hemangioma of the rib treated by surgical resection after CT and MR findings.
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CASE REPORT
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A 62-year- old male was admitted to the Thoracic Surgery Department for an asymptomatic chest mass. There was no history of trauma to the chest wall. Chest Roentgenogram showed a non-homogeneous round mass 5.0 cm in diameter on the right upper lung field. (Figure 1
) Chest magnetic resonance imaging showed a 5.0 cm mass with bony erosion along the right fifth rib (Figure 2A, 2B, 2C). The patient underwent surgical resection of the involved rib. Macroscopically, a well defined tumor measuring 6.0 cm x 5.0 cm x 3.5 cm was seen originating from the fifth rib and enlarging towards the thoracic cavity without the involvement of the pleura. The mass including intercostal muscles and 4.0 cm normal rib tissue on both sides was resected. It had well defined surgical margins and covered with fibrous stroma. The cut surface of the mass had a polycystic appearance (Figure 3A, 3B). Microscopically, the tumor was composed of thick-walled lattice-like pattern of endothelial-lined cavernous spaces filled with blood (Figure 4A, 4B). The surgical margins were negative for tumor cells. The patient was discharged 7 days after the operation and a follow-up after 4 months showed no evidence of recurrence.
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Figure 1. Chest roentgenogram showing an extrapleural well–circumscribed convex opacity on the upper lung field.
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Figure 2. Magnetic resonance imaging showing low signal on T1 weighted images (A), high signal on T2 weighted images (B), and enhancement by contrast media (C).
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Figure 4. Microscopic findings in the resected mass, large dilated vessels with a single layer of endothelial cells (H.E x 50) (A), Factor VIII-related antigen-positive endothelial cells (B).
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DISCUSSION
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Most hemangiomas account for approximately 1% of all bone tumors.1 Histologically, there are two types of hemangiomas - cavernous and capillary. The cavernous types consist of large dilated vessels lined by a single layer of endothelial cells surrounded by a fibrous stroma layer. The less common, capillary hemangioma shows numerous tortuous small vascular channels lined with epithelium. Hemangiomas arising from the ribs are extremely rare with few cases reported in the literature.2–6 They are usually asymptomatic hence their diagnosis is usually made incidentally on routine chest roentgenogram. It shows a mass lying on the chest wall or in the lung fields. Chest computed tomography and magnetic resonance imaging can more clearly identify the size and the extent of cortical destruction caused by it. It is reported that rib tumors represent 5.9% of the primary bone tumors and 89% of them are malignant.7–8 The differential diagnosis of rib tumor may include metastatic and primary malignant rib tumors (myeloma, chondrosarcoma, and osteogenic sarcoma or Ewing sarcoma) or benign rib tumors (fibrous dysplasia, ostheochondroma, eosinophilic granuloma, aneurysmal bone cyst or hemangioma).Cavernous hemangioma of the rib is extremely rare and it should be considered in the differential diagnosis of rib tumors, especially in asymptomatic patients5. Since more than half of the rib tumors are malignant, needle biopsy should be avoided due to the risk of seeding the needle tract unless multiple myeloma or metastatic disease is highly suspected.3,5,7 Needle biopsy of cavernous hemangioma may cause bleeding. However, some authors have used a fully automated thin needle device which is safe and useful in obtaining a definite diagnosis even with hemangioma of the rib.6 Hemangiomas are rare and benign tumors and the final diagnosis can be made only by pathologic examination.
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REFERENCES
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