Question

A red soft to firm swelling on the sternum, biopsied with the histology shown above. What is the diagnosis?

• A. Hemangioma
• B. Osteochondroma
• C. Osteoid osteoma
• D. Paget disease

Hint:

A red bony swelling with vascular channels on histology.

Answer 1

The Correct Option is A

Step 1: Read the clinical clue. A red, soft to firm swelling suggests a vascular lesion, and the bone involved is the sternum, a flat bone.

Step 2: Match the histology. Intraosseous hemangioma is a slow growing vascular neoplasm of the medullary cavity. Histology shows hamartomatous vascular channels lined by endothelium, often with admixed fat, smooth muscle, fibrous tissue and thrombi. These lesions are usually asymptomatic but can appear as a palpable mass, especially in the skull and flat bones.

Step 3: Reject the distractors. Osteochondroma is a cartilage-capped bony outgrowth, not vascular. Osteoid osteoma is a small painful lesion with a radiolucent nidus surrounded by reactive bone, classically causing night pain relieved by NSAIDs. Paget disease is a remodeling disorder with mosaic bone, not a discrete red vascular swelling. The combination of a red vascular swelling and vascular histology confirms hemangioma.