High Grade Angiosarcoma of Bone


High grade angiosarcoma seems to have two distinct clinical presentations.  First, the lesion can present as multiple lesions in a single bone, two or more adjacent bones, or perhaps all the bones of a limb. These lesions seem to have an indolent course and the prognosis remains good.  The second presentation is that of single or multiple rapidly progressive lesions that  metastasize to other bones or to the lung this form of the disease has a very poor prognosis. This case illustrated the later type.

The bony lesions of high grade angiosarcoma tend to be eccentric, purely lytic, metaphyseal and diaphyseal, with no visible matrix mineralization and focal destruction of the cortex. They have a very aggressive appearance but there is no periosteal reaction and very little soft-tissue extension, similar to what might be seen in metastatic lesions from lung. They tend to occur as multiple lesions in the same bone or contiguous bones, as shown in this case.


The radiographs shown here are of a 35 year old recently married auto mechanic whose wife had just had their first baby. He presented with severe pain in the distal femur. The initial work-up revealed multiple lesions in both lower extremities, including a lesion in the mid-diaphysis of the ipsilateral tibia and two lesions in the contralateral femur. A CT scan of the chest showed pulmonary nodules. Biopsy showed high-grade angiosarcoma of bone.


Since there was already widespread metastasis at presentation, surgical removal of the tumor and limb sparing surgery was not a viable option. Treament included locked intramedullary rodding of the femur and tibia to prevent pathologic fracture. Radiation of the rodded bones and the opposite femur as well as adjuvant chemotherapy was given. A lesion appeared at the tip of the tibial rod just above the ankle, just outside the radiated field. Due to the risk of fracture at this site, the patient was given additional radiation to the area of recurrence.


The tumor failed to show any significant response to chemotherapy and the patient had a rapily progressive course . He expired approximately one year from the time of initial diagnosis.








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