Intraosseous hemangioma (IOH) is an extremely rare anomaly, characterized by slow-growing benign vascular malformations, usually in the vertebral column and skull. IOH accounts for less than 1% of all tumors affecting the bone. Most frequently affected bones include the mandible, maxilla, the vertebral column, and the calvaria. Histologically, the hemangiomas can be classified as venous, cavernous, or capillary type, according to their vascular network. The cavernous type is an enlarged mass of blood-filled sinusoidal channels which erodes and displaces normal tissues. The capillary type of hemangioma, on the other hand, consists of multiple tufts of capillaries in radiating loops. The most common form, however, is a mixed form, consisting of both cavernous and capillary type of hemangiomas. This condition is seen more in women than in men, with a ration of 3:1. The most common age of presentation is in the fourth and fifth decades of life.
In most cases, the condition remains asymptomatic, and in a lot of the cases, the finding of the tumors is incidental. Diagnosis is best done with the help of CT or MRI scan. Differential diagnosis includes aneurismal bone cyst, histiocytosis-x, fibrous dysplasia, dermoid and epidermoid cysts, meningioma, osteoma, and osteogenic sarcoma. Confirmation of diagnosis can only be done upon biopsy. The choice of treatment is surgery involving en bloc resection, and establishment of normal bony margins by drill cutterage. Malignant transformation has been observed very rarely, and is reported only after radiation therapy. Therefore, radiotherapy is not recommended.