J Korean Orthop Assoc.  2012 Dec;47(6):457-462. 10.4055/jkoa.2012.47.6.457.

Metal Associated Angiosarcoma of the Distal Femur

• Park JW
• Cho HM
• Park C
• Kim JH
• Bong HS

• KMID: 2185310
• DOI: http://doi.org/10.4055/jkoa.2012.47.6.457

Abstract

Malignant vascular tumors (angiosarcoma) of bone are rare and represent a less than 1% of malignant bone tumors. The authors report a case of a patient with angiosarcoma misdiagnosed as infection, which developed adjacent to a stainless steel intra-medullary nail used for fixation of a femur fracture.

Keyword

hemangiosarcoma; bone neoplasms; intramedullary nailing

MeSH Terms

Bone Neoplasms
Femur
Fracture Fixation, Intramedullary
Hemangiosarcoma
Humans
Nails
Stainless Steel
Stainless Steel

Figure

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  Figure 1 (A) An anteroposterior and lateral radiographs of the left femur show lytic destruction of bone adjacent to intra-medullary nail fixation placed for the femur fracture. (B) Computed tomography revealed that the localized bony destruction in both cortical and cancellous bones around the distal part of intramedullary nail.

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  Figure 2 (A) Fourteen days after the first operation, pathological femoral fracture and rapid osteolysis has developed. (B) For the pathological fracture, antibiotic beads were inserted in distal femur, and the femur was externally-fixed to prevent any further progress of the pseudarthrosis.

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  Figure 3 (A) Histologic examination of a specimen at medium power shows malignant spindle cell proliferation associated with multiple vascular channels (H&E, ×200). (B) Neolpastic cells uniformly expressing CD 34, original magnification ×400.

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  Figure 4 (A) Disarticulation of the hip was performed two weeks later from the last operation. (B) A posteroanterior radiograph of the chest revealed diffuse haziness over the entire left lung field, with pleural effusion.

Reference

1. Unni KK. Dahlin's bone tumors. General aspects and data on 11,087 cases. 1996. 5th ed. Philadelphia: Lippincott-Raven;317–331.

2. Weiss SW, Goldblum JR, Enzinger FM. Enzinger and Weeiss's soft tissue tumors. 2001. 4th ed. St. Louis: Mosby;917–954.

3. Hasegawa T, Fujii Y, Seki K, et al. Epithelioid angiosarcoma of bone. Hum Pathol. 1997. 28:985–989.

4. McDonald DJ, Enneking WF, Sundaram M. Metal-associated angiosarcoma of bone: report of two cases and review of the literature. Clin Orthop Relat Res. 2002. (396):206–214.

5. Boutin RD, Spaeth HJ, Mangalik A, Sell JJ. Epithelioid hemangioendothelioma of bone. Skeletal Radiol. 1996. 25:391–395.

6. Lewis JM, Sondak VK. Angiosarcoma an Electronic Sarcoma Update Newsletter(ESUN) article. Liddy Shriver Sarcoma Initiative. 2008. 12. 08. accessed 2010 Aug. Sarcoma LLearning Center;Available from: http://sarcomahelp.org/learning_center/angiosarcoma.html.

7. Durbin M, Randall RL, James M, Sudilovsky D, Zoger S. Ewing's sarcoma masquerading as osteomyelitis. Clin Orthop Relat Res. 1998. (357):176–185.

8. Willis RB, Rozencwaig R. Pediatric osteomyelitis masquerading as skeletal neoplasia. Orthop Clin North Am. 1996. 27:625–634.

9. Wenger DE, Wold LE. Malignant vascular lesions of bone: radiologic and pathologic features. Skeletal Radiol. 2000. 29:619–631.

10. Campanacci M. Campanacci M, Enneking WF, editors. Hemangioendothelioma bengin, heman-gioendothelioma low grade, hemangioendothe lioma high grade (angiosarcoma). Bone and soft tissue tumors. 1999. 2nd ed. New York: Springer-verlag;623–641.