A Rare Cause of Postoperative Bleeding from A Lytic Lesion of Calcaneum

INTRODUCTION Post-operative excessive bleeding can be due to various causes, which may platelet deficiency, both quantitative and qualitative, vascular disorder, clotting factor defects and excessive fibrinolysis. Rarely can be due to some undiagnosed malignant tumours. Angiosarcoma of bone is an exceedingly rare primary bone malignancy. We report an interesting and rare case of an intraosseous angiosarcoma that presented as an excessive postoperative bleeding with diagnostic dilemma. CASE REPORT A twenty eight year old gentleman admitted to our hospital with history of continuous bleeding from surgical site over left heel since three months. About six months ago he was evaluated elsewhere for a painful progressive lesion in the left calcaneum. Following which he underwent curettage of lesion with bone grafting. One month after this he was re-operated for recurrence with curettage with bone cementing. Curetted material on both occasions was reported as aneurysmal bone cyst. One month following the second surgery, surgical scar over the outer aspect of left heel opened out and started to bleed continuously. X rays and MRI done before surgical treatment were suggestive of aneurysmal bone cyst Investigations for clotting and bleeding disorders were normal. The granulation tissue from the floor of the cavity was curetted and sent for histopathology, which was reported as angiosarcoma. CONCLUSION Intraosseous angiosarcoma is a rare primary bone tumour. The diagnosis is often delayed because of the non-specific clinical presentation and radiological features. Clinicopathological correlation is very important to differentiate aneurysmal bone cyst from the aggressive type of vascular malignancies. The clinical course of disease is aggressive, as demonstrated by this current case. The initial biopsies done twice at curettage were not diagnostic and suggested the presence of a benign aneurysmal bone cyst. Due to the excessive postoperative bleeding, repeat biopsy performed which diagnosed angiosarcoma.