Oral Medicine & Pathology

Hemangiosarcoma : imaging , clinical findings , pathology , treatment , epidemiology





  •  Hemangiosarcomas can arise from endothelial cells in almost any organ.
  • The head and neck represent the most common sites for these tumors, and they are predominantly located in the scalp.
  • This malignancy is found mainly in the older age group but is also reported in the pediatric age group.
  • Males are more commonly affected, with a sex ratio of M:F of 4: 1 .

Clinical Findings

  •   Most patients present with a mass.
  • The lesions appear blue with a peripheral zone of erythema


  •  Hemangiosarcomas can be classified into two groups.
  • Low-grade malignancy shows better tumor differentiation, whereas the high-grade variety exhibits poorly or undifferentiated tumor tissues.
  • High-grade tumors tend to show wide and deep tissue infiltration, and the adjacent bony structures may be eroded.
  • Hemangiosarcomas show cervical nodal or pulmonary metastasis in about one third of patients.


  •   Treatment depends on the site and size of the tumor.
  • Surgical excision is the primary form of treatment.
  • Radiation therapy can also be used.
  • The most important reason for treatment failure is the underestimation of tumor volume.
  • The prognosis is generally poor with more than 50% of patients dying within 5 years.

Imaging Findings


  • Contrast-enhanced CT shows an enhancing mass.
  • There may be associated bony erosion.
  • The presence of tumor bleeding may be masked following contrast enhancement. 


  •  Hemangiosarcomas are often hemorrhagic and on T l – and T2-weighted images, high signalsmay be detected.
  • The neoplasm shows intense enhancement following the injection ofcontrast. On T2-weighted images, the tumor shows high signals  

Imaging Pearls

  • The MR and CT findings of hemangiosarcomas are nonspecific but this diagnosis maybe suggested if tumor hemorrhage is detected.
  • Hemorrhage on CT may be missed when only contrast-enhanced examinations are performed .
  • Tumor size estimation is frequently underestimated clinically and this may result in treatment failure.
  • It is therefore important to delineate the full tumor extent



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