Cystic angiomatosis of bone with sclerotic changes mimicking osteoblastic metastases

Abstract

Five unusual cases of cystic angiomatosis of bone which presented with the radiologic appearance of osteoblastic lesions are reported. Three patients were female (ages 37, 41, and 65 years) and two were male (ages 24 and 66 years). Although cystic angiomatosis of bone usually produces widespread osteolytic lesions with a honeycombed appearance in the skeletal system, multiple osteoblastic lesions mimicking metastatic osteoblastic carcinoma are sometimes seen. This radiological presentation has not been well emphasized in previous reports. Histologically, in addition to the angiomatous lesions, both mature thickened lamellar bone trabeculae and immature trabeculae of woven bone were found. In one of our patients, increasing density of the osteoblastic lesions was noted over time. One previous study has suggested that the age of the lesions of cystic angiomatosis is related to radiographic density. It is important to recognize this uncommon variant of cystic angiomatosis and to include this entity among the radiologic differential diagnoses when multiple osteoblastic lesions are encountered.

Imaging features of systemic cystic angiomatosis

“…The possible differential diagnoses in the presence of disseminated lytic angiomatous features include histiocytosis X, hyperparathyroidism, polyostotic fibrous dysplasia, metastases and lymphomas [4,7,8]. Nevertheless for all these conditions, the radiolucent area of osteosclerosis is often absent and the typical angiomatous presentation described above is not present.…”

Protracted disseminated skeletal metastases from angiosarcoma of the spleen

“…A similar case, 3 years after splenectomy, was reported by Wang et al [7] in 2004. In addition, the fact that the radiographic findings presented as well circumscribed osteosclerosis and osteolytic lesions to a much lesser extent, unfolded rising doubt about the aggressiveness of the vascular lesion and a close resemblance with angiomatosis was stated by the radiologists [4,13,14]. Further radiographic differential diagnosis included metastatic disease originating from another malignancy and less likely lymphoma or sarcoidosis.…”

Cystic angiomatosis with splenic involvement: unusual MRI findings

“…Cystic angiomatosis of bone has been reported in multiple case reports and excellent reviews [5]. Multiple osteolytic lesions of variable size are seen throughout the skeleton.…”