Cavernous Hemangioma of the Leg

The reason for reporting this case is its relative infrequency and the puzzling roentgenologic aspects as to whether the tumor mass, as observed on the film, sprang from the periosteal bone layer or secondarily involved bone. The patient was a white female, aged 63 years. To use her own words, the growth began 22 years ago, as a “small hole in the left leg, which alternately would heal over and break down again.” Ten years ago it began to grow and amputation of the limb was advised, but refused. It has grown steadily larger, and the leg is painful when the patient is walking. The tumor bleeds readily and on one occasion there was a distinct hemorrhage. Otherwise, the previous history of the patient has no bearing. Spinal and blood Wassermanns are negative. Complete blood count is normal. There is a large tumor mass (Figs. 1 and 2), ulcerating and cirsoid in type, springing from the soft tissue of the left leg on the anterior aspect. The tibialis anterior is the muscle involved. Radiographic Appearance.—There is a large nodular, cirsoid oval tumor mass in the anterior aspect of the lower third of the left leg, which extends posteriorly into the interosseous space. There are two or three small bone spicules lying at right-angles to the shaft of the tibia and penetrating the growth. The periosteum is proliferated and elevated along the anterior aspect of the tibia, and the cortex is thickened. There is no invasion of the medullary canal nor any breaking down of the cortex of the tibia. There is sclerosis of the cortex in the region of the head of the tibia along the inner aspect of the head and neck. The fibula shows definite periosteal reaction and proliferation along both borders of the shaft. There is decalcification of the shaft of the fibula. In the neck of the fibula is a small circular area of bone rarefaction, with a calcific border suggesting an old healed cyst. We thought that a tumor arising from the bone was definitely excluded and that a periosteal origin of the tumor, a simple fibroma, or one undergoing sarcomatous change, was the most likely diagnosis. The appearance of the mass definitely excluded syphilis and osteogenic sarcoma. As in this case, the diagnosis is seldom made before operation. Operation.—Using a tourniquet above the tumor, the entire growth was removed by Dr. Teller. Moderate hemorrhage was encountered. The underlying periosteum was removed with the growth. Macroscopy.—The specimen consists of a segment of tissue measuring. 9.5 × 7.5 × 3 centimeters. Superficially it is a cauliflower growth—an ulcerating, fungating, irregularly shaped mass having an elliptical edge. On cross-section several hemorrhagic cyst-like spaces are noted, the edges of these areas being indurated and necrotic.