Hemangioma of the Rib Mimicking Chondrosarcoma: A Report of Two Cases and Literature Review

Abstract

Cases. Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision was performed with no surgical complication. Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone. Conclusion. We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the en bloc excision without biopsy can be a practical treatment option.

Case Report: Cavernous hemangioma of rib: an extremely rare venous malformation but easily misdiagnosed as aggressive tumors

“…Bone hemangiomas are benign malformations that have small or large vascular channels ( 6 , 7 ). Typically, hemangiomas of bone involve vertebral bodies, followed by the craniofacial skeleton and long bones ( 6 ).…”

“…Bone hemangiomas are benign malformations that have small or large vascular channels ( 6 , 7 ). Typically, hemangiomas of bone involve vertebral bodies, followed by the craniofacial skeleton and long bones ( 6 ). Cavernous hemangioma of the rib is an extremely rare benign malformation involving the bone marrow and cortex to help ( 8 , 9 ).…”

“…Moreover, the malformations contain rich vascular channels, and a biopsy may cause bleeding. Due to malformation seeding risks through the biopsy tract, some authors recommend avoiding biopsy ( 6 ). In addition, considering that venous malformations of rib malformations are often malignant and rib hemangiomas often have imaging findings of cortical disruption, we advocate aggressive surgical resection.…”

“…For rib hemangiomas, the widely accepted surgical approach is to remove the primary rib along with the malformations ( 2 – 37 ). To achieve optimal oncological outcomes, an excision margin of at least 2 mm is recommended because this margin is considered a safe margin for high-grade chondrosarcomas according to a previous report ( 6 ). Thoracic reconstruction should be required if the lump is large in size.…”