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Vascular lesions of bone in children, adolescents, and young adults. A clinicopathologic reappraisal and application of the ISSVA classification

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Abstract

Vascular lesions of bone are rare and their terminology is not standardized. Herein, we report 77 patients with such lesions in order to characterize their morphologic spectrum and the applicability of the International Society for the Study of Vascular Anomalies (ISSVA) classification. In this system, malformations are structural anomalies distinguishable from tumors, which are proliferative. The radiologic images/reports and pathologic materials from all patients were reviewed. All lesions were either restricted to bone or had minimal contiguous soft tissue involvement with the exception of some multifocal lymphatic lesions that extensively affected soft tissue and/or viscera. We found that certain lesions of bone often regarded as tumors should be classified as malformations. Malformations (n = 46) were more common than tumors (n = 31); lymphatic and venous malformations were equally frequent. In the tumor category, hemangioendothelioma and epithelioid hemangioma were the most common. We also describe new vascular entities that arise in or involve bone. Utilizing the ISSVA approach, the diverse and often contradictory terminology of vascular lesions of bone can be largely eliminated. Standardized nomenclature is critical for scientific communication and patient management, and we hereby recommend the ISSVA classification be applied to vascular lesions of bone, just as for skin, soft tissue, and viscera.

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Acknowledgments

We are indebted to the technical staff of the Department of Pathology of Children’s Hospital Boston and the Institute of Pathology, University Hospital Basel for performance of immunohistochemistry and coordinators of the Vascular Anomalies Center of the Children’s Hospital Boston. We thank Thomas Schuerch and Jan Schwegler for scanning radiographs and whole mount sections and for help with the digital imaging. Above all, we are grateful to Petra Huber of the Basel Bone Tumor Reference Center for her invaluable assistance in retrieval of slides, clinical charts, and radiographic documentation.

We declare that we have no conflict of interest

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Authors and Affiliations

  1. Institute for Pathology, University Hospital Basel, Basel, Switzerland

    Elisabeth Bruder & Gernot Jundt

  2. Institute of Surgical Pathology, Paediatric Pathology Section, University Hospital Zurich, Zurich University, Zurich, Switzerland

    Elisabeth Bruder

  3. Bone Tumor Reference Center University Hospital Basel, Basel, Switzerland

    Gernot Jundt

  4. Department of Oncology, Children’s University Hospital Basel, Basel, Switzerland

    Johannes Rischewski

  5. Department of Pathology, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Antonio R. Perez-Atayde & Harry P. W. Kozakewich

  6. Department of Radiology, Children’s Hospital Boston, Harvard Medical School, Boston, MA, 02115, USA

    Ahmad I. Alomari

  7. Department of Surgery, Children’s Hospital Boston, Harvard Medical School, Boston, MA, 02115, USA

    Steven J. Fishman

  8. Department of Plastic Surgery, Children’s Hospital Boston, Harvard Medical School, Boston, MA, 02115, USA

    John B. Mulliken

  9. Vascular Anomalies Center, Children’s Hospital Boston and Harvard Medical School, Boston, MA, 02115, USA

    Ahmad I. Alomari, Steven J. Fishman, John B. Mulliken & Harry P. W. Kozakewich

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  1. Elisabeth Bruder
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  2. Antonio R. Perez-Atayde
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Correspondence to Harry P. W. Kozakewich.

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Bruder, E., Perez-Atayde, A.R., Jundt, G. et al. Vascular lesions of bone in children, adolescents, and young adults. A clinicopathologic reappraisal and application of the ISSVA classification. Virchows Arch 454, 161–179 (2009). https://doi.org/10.1007/s00428-008-0709-3

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  • DOI: https://doi.org/10.1007/s00428-008-0709-3

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