CASE REPORT
Rib hemangioma: uncommon benign vascular tumor
Ihsan Alloubi&Aziz Mehmal&Souhail Boubia&
Mohammed Ridai
Received: 9 August 2011 / Accepted: 3 August 2013
#Indian Association of Cardiovascular-Thoracic Surgeons 2014
Introduction
Rib hemangioma is an uncommon benign vascular tumor.
This diagnosis is often forgotten in the differential diagnosis of a chest wall tumor. This case report adds to the literature on this rare condition and discusses the issues in the diagnosis of chest wall tumors.
Case report
A-63-year old woman with no medical history was admitted for a left chest wall mass which was incidentally discovered on routine chest X-ray (Fig.1). Computed tomography (CT) showed localized expansive growth along the inner surface of the 3rd left rib measuring 4.5×6 cm projecting into the tho- racic cavity. The bony cortex was disrupted, and there were
some areas of calcification. The lesion was solitary, and there was no pleural effusion (Fig.2).
The radiological diagnosis was an aggressive, primary bone neoplasm like Ewing sarcoma. The lesion was resected with macroscopically clear rib margins.
On histologic examination, it was found that the bone marrow had been replaced by large, thin-walled, dilated ves- sels which contained red blood cells; these vessels were surrounded by a fibrous stromal layer (Fig.3). There was no cellular atypia. The diagnosis was a benign rib hemangioma.
Fig. 1 Chest radiograph showing an expansile lesion of the left 3rd rib without an associated soft tissue component
I. Alloubi
Thoracic Surgery Department, C.H.U OUJDA, Oujda, Morocco A. Mehmal
Pneumology, CHU Ibn Tofail, Marrakech, Morocco S. Boubia
:
M. RidaiThoracic Surgery CHU, Casablanca, Morocco I. Alloubi (*)
Thoracic Surgery Department, Hôpital Al FARABI, 60000 Oujda, Morocco
e-mail: ialloubi@yahoo.fr Indian J Thorac Cardiovasc Surg DOI 10.1007/s12055-014-0271-3
Comments
Bone hemangiomas are benign vascular tumors and account for about 1 % of all bone tumors [1]. Most of them are found in the spine and the skull. Rib hemangioma is very rare—to our knowledge, only 14 cases have been reported in literature [2].
Patients are usually asymptomatic, and discovery of tu- mor is usually made incidentally during a chest radiograph examination. Chest CT and magnetic resonance imaging can more clearly identify the size and the extent of cortical destruction [3]. When an expansible rib lesion exhibiting fine intraosseous trabeculations is seen, a hemangioma should be included in the differential diagnosis, and needle biopsy should be avoided due to the risk of bleeding. [4]
Monobloc surgical resection of the affected rib is the treat- ment of choice. There are four histologic variants of hem- angioma, namely cavernous, capillary, arteriovenous, and venous. Rib hemangiomas are usually of the cavernous type. [5] Preoperatively, feeding arterial vessels may be embolized to aid surgical resection and reduce intraopera- tive bleeding.
References
1. Clements RH, Turnage RB, Tyndal EC. Hemangioma of the rib: a rare diagnosis. Am Surg. 1998;64:1027–9.
2. Nakamura H, Kawasaki N, Taguchi M, Kitamura H. Cavernous hem- angioma of the rib diagnosed preoperatively by percutaneous needle biopsy. J Thorac Cardiovasc Surg. 2007;55:134–7.
3. Jeung MY, Gangi A, Gasser B, et al. Imaging of chest wall disorders.
Radiographics. 1999;19:617–37.
4. Yeow KM, Hsieh HC. Thoracic outlet syndrome caused by first rib hemangioma. J Vasc Surg. 2001;33:1118–21.
5. Resnick D, Kyriakos M, Greenway GD. Tumors and tumor-like lesions of bone. Diagnosis of Bone and Joint Disorders. 4th ed.
2002. 3979–85.
Fig. 3 Low-power microscopy showing that the bone marrow has been replaced by numerous thin-walled blood vessels with no cellular atypia, confirming the diagnosis of a benign hemangioma
Fig. 2 Bone window CT images of the lateral 3rd rib showing a bony lesion with a cortical disruption and a well-defined expansile soft tissue component. Fine bony trabeculae and heterogeneous density can be appreciated in the expansile component. There is no periosteal reaction
Indian J Thorac Cardiovasc Surg
