From the Guidelines
Hemangiomas can indeed occur in the bone, specifically as primary bone neoplasms, as mentioned in the management of vertebral compression fractures 1. These benign vascular tumors are composed of blood vessels and can develop within the skeletal system, most commonly in the spine and skull. Bone hemangiomas are typically asymptomatic and are often discovered incidentally during imaging studies performed for other reasons. They appear as well-defined lesions with characteristic patterns on X-rays and CT scans. Most bone hemangiomas require no treatment as they rarely cause problems. However, if they grow large enough to cause pain, fractures, or neurological symptoms, treatment options include radiation therapy, embolization, vertebroplasty, or surgical removal. Some key points to consider about bone hemangiomas include:
- They are thought to result from abnormal blood vessel development rather than being true neoplasms
- They occur in approximately 10% of the population, with higher prevalence in middle-aged adults
- They show no significant gender preference
- The management of painful vertebral compression fractures, including those caused by hemangiomas, has the potential for improving quality of life, increasing the expectancy of an independent and productive life, and preventing superimposed medical complications, as noted in the ACR Appropriateness Criteria 1.
From the Research
Hemangiomas in Bone
- Hemangiomas can occur in the bone, specifically in the spine, and are known as vertebral hemangiomas 2, 3, 4, 5, 6.
- Vertebral hemangiomas are benign tumors formed from a vascular proliferation in bone marrow spaces limited by bone trabeculae 2.
- They are the most common benign tumors of the spine, with an incidence range of 10-12% 4.
- Approximately 1-2% of cases develop clinically significant symptoms, causing the necessity for treatment 4.
Characteristics of Vertebral Hemangiomas
- Vertebral hemangiomas are composed of newly formed blood vessels with normal structure and without arterio-venous shunt 6.
- There are two microscopic types of vertebral hemangiomas: cavernous angiomas and capillary angiomas, which frequently coexist 6.
- The vascular malformation is not separated from the bone tissue by a capsule, and the surrounding osseous lamellae usually show secondary osteolysis and osteocondensation 6.
Treatment Options
- Treatment options for symptomatic vertebral hemangiomas include surgical intervention, percutaneous ethanol injection, radiofrequency ablation, and radiation therapy 3.
- Radiation therapy has been shown to be effective in the management of symptomatic vertebral hemangiomas, with complete relief of symptoms in 54% of cases and partial relief in 32% of cases 4.
- The optimal dose of radiation therapy is 30-40 Gy in 3-4 weeks, with good functional recovery and minimal toxicity 4, 5.