J Korean Soc Radiol.  2011 Dec;65(6):607-611. 10.3348/jksr.2011.65.6.607.

Epithelioid Hemangioendothelioma of the Femur with Benign Cystic Appearance

• Kim YG
• Choi JA
• Chung JH
• Oh JH
• Kang HS

• KMID: 2002930
• DOI: http://doi.org/10.3348/jksr.2011.65.6.607

Abstract

An epithelioid hemangioendothelioma is an intermediate grade tumor between hemangioma and angiosarcoma that frequently shows marked enhancement because it is a vascular tumor. Herein, we describe a rare case of a malignant epithelioid hemangioendothelioma of the femur that was mistaken as a benign lesion such as a simple bone cyst or fibrous dysplasia because the tumor had a benign cystic appearance on MRI and its imaging findings showed a histopathologic correlation.

MeSH Terms

Bone Cysts
Bone Neoplasms
Femur
Hemangioendothelioma, Epithelioid
Hemangioma
Hemangiosarcoma

Figure

• 

  Fig. 1 On the right femur AP (A) and lateral (B) views, an elongated, radiolucent, slightly expansile lesion is seen at right femur shaft, extending from the proximal metadiaphysis to the distal metaphysic area. A pathologic fracture is noted at distal 2/3 of the femur (arrowheads). Note.-AP = anteroposterior

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  Fig. 2 MR images of right femur. A. On a coronal T2-weighted image (TR/TE = 3,734/100), the lesion extends from the proximal metadiaphysis area spanning from just below the intertrochanteric area to the distal femur up to the prosthesis. The lesion shows high signal intensity with focal intermediate to low signal intensity foci and numerous septae (arrowheads). A fracture is noted at distal two-thirds of femur. B. On a sagittal T1-weighted image (TR/TE = 421/7), the lesion is shown to have intermediate signal intensity similar to muscle. C. On a coronal post-contrast fat suppression T1-weighted image (TR/TE = 600/6), the lesion shows thin peripheral enhancement and enhancement of the septae (arrowheads). Note.-TR = repetition time, TE = echo time

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  Fig. 3 Histopathologic specimen images. A. On histopathologic examination, endothelial lining at the margin of the tumor and numerous vessels with RBCs (arrowheads) are seen in fragments of tissue obtained by curettage (H&E, × 10). B. Aberrant vessel formation and extravasated RBCs (arrowheads) are characteristic (H&E, × 400). C. Atypical mitoses (arrowheads) are common (H&E, × 400). Note.-RBC = red blood cell

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