EURORAD ESR

Case 9298

Epithelioid hemangioendothelioma of the femur

Author(s)
Manenti G, Antonicoli M, Llubani R, Squillaci E, Dragoni M, Ippolito E, Simonetti G
 
Patient
male, 27 year(s)
 
 
  • Figure 1
    Digital radiography

    Digital radiography shows the presence of an extended endosteal bone neoformation in the context of a proximal diaphysis morphostructural alteration (cranio-caudal extension of 17 cm and maximum transverse diameters...

     
    Area of Interest: Bones; Musculoskeletal bone; Musculoskeletal system; Imaging Technique: Digital radiography;
     
     
  • Figure 2
    CT scan
     

    Axial CT scan reconstruction shows the presence of a gross expansive lesion involving the right femur proximal diaphysis, which appears to swell the cortical bone with discontinuities and periosteal reaction.

     
    Area of Interest: Bones; Extremities; Musculoskeletal bone;

    Coronal CT scan reconstruction shows the presence of a gross inhomogeneous expansive solid lesion with calcifications involving the right femur proximal diaphysis with the cortical bone swelling and thick periosteal...

     
    Area of Interest: Bones; Extremities; Musculoskeletal bone; Imaging Technique: CT;

    MPVR CT reconstruction shows the presence of a gross expansive lesion involving the right femur proximal diaphysis.

     
    Area of Interest: Bones; Extremities; Musculoskeletal bone;
     
     
  • Figure 3
    MR images
     

    T1-weighted MR image with fat suppression after Gadolinium i.v. injection demonstrates a lesion composed of juxtaposed hypocellular tissue, with mild-high contrast enhancement.

     
    Area of Interest: Bones; Imaging Technique: MR;

    MRA MIP reconstruction coronal plane: vascular pedicles feeding the lesion from the right femoral artery.

     
    Area of Interest: Vascular; Imaging Technique: MR-Angiography;

    MRA MIP reconstruction axial plane: vascular pedicles feeding the lesion from the right femoral artery.

     
    Area of Interest: Vascular; Imaging Technique: MR-Angiography;
     
     
  • Figure 4
    Fusion PET-CT images
     

    Fusion PET-CT axial image shows high and heterogeneous 18F-FDG uptake by the neoplastic mass (SUV max.3.5).

     
    Area of Interest: Bones; Oncology; Imaging Technique: PET-CT;

    Fusion PET-CT coronal image shows an 18F-FDG avid neoplastic mass.

     
    Area of Interest: Bones; Imaging Technique: PET-CT;
     
     
  • Figure 5
    Post-surgery digital radiography

    Post-surgery digital radiography documents cadaveric femur transplantation and fibula autologous graft with multiple bone screws at the diaphysis of the right femur.

     
    Area of Interest: Bones; Imaging Technique: Digital radiography;
     
     
  • Figure 6
    Post-surgery DSA image

    Post-surgery DSA image with superficial femoral and fibular pedicle arteries latero-lateral anastomosis.

     
    Area of Interest: Vascular;
     
     
  • Figure 7
    3D shaded-surface rendering CT reconstruction

    3D shaded-surface rendering CT reconstruction highlites anatomical proximity of screws (red) and grafts.

     
    Area of Interest: Bones; Procedure: Computer Applications-3D;
     
     
  • Figure 8
    Lesion exposure

    Lesion exposure during surgical excision.

     
    Area of Interest: Anatomy; Bones; Procedure: Intraoperative; Removal; Surgery;
     
     
  • Figure 9
    Gross specimen
     

    Gross specimen cut surfaces with solid inhomogeneous hypervascularised lesion. Poorly-defined intramedullary mass, extending through cortex with moth-eaten bone destruction and aggressive periostal reaction.

     
    Area of Interest: Anatomy; Bones; Procedure: Biopsy; Removal; Surgery;

    Gross specimen cut surfaces with solid inhomogeneous hypervascularised lesion. Poorly-defined intramedullary mass, extending through cortex with moth-eaten bone destruction and aggressive periostal reaction.

     
    Area of Interest: Anatomy; Bones; Procedure: Biopsy; Removal; Surgery;
     
     
  • Figure 10
    Hematoxil-Eosin histopathology

    Lining cells of gland-like structure show irregular vesicular or optically clear nuclei with prominent basophilic nucleoli and occasional vacuolated cytoplasm. Epithelioid haemangioendothelioma morphology...

     
    Area of Interest: Musculoskeletal soft tissue;
     
     
  • Figure 11
    Hematoxil-Eosin histopathology

    The epithelioid histological subtype of haemangioendothelioma has epithelial-like cells lining the vascular channels that are large and cuboidal and contain abundant eosinophylic cytoplasm.

     
    Area of Interest: Musculoskeletal soft tissue;
     
     
  • Figure 12
    Hematoxil-Eosin histopathology

    The epithelioid histological subtype of haemangioendothelioma has epithelial-like cells lining the vascular channels that are large and cuboidal and contain abundant eosinophylic cytoplasm.

     
    Area of Interest: Musculoskeletal soft tissue;
     
     
  • Figure 13
    CD34 immunopathology

    Immunohistochemical study is helpful in confirming the diagnosis by identifying the markers for vascular endothelial cell (CD34+).

     
    Area of Interest: Musculoskeletal soft tissue;
     
     
  • Figure 14
    CD34

    Immunohistochemical study is helpful in confirming the diagnosis by identifying the markers for vascular endothelial cell (CD34+).

     
    Area of Interest: Musculoskeletal soft tissue;
     
     
Digital radiography shows the presence of an extended endosteal bone neoformation in the context of a proximal diaphysis morphostructural alteration (cranio-caudal extension of 17 cm and maximum transverse diameters of 73 x 73 mm)
 
Axial CT scan reconstruction shows the presence of a gross expansive lesion involving the right femur proximal diaphysis, which appears to swell the cortical bone with discontinuities and periosteal reaction.
 
Coronal CT scan reconstruction shows the presence of a gross inhomogeneous expansive solid lesion with calcifications involving the right femur proximal diaphysis with the cortical bone swelling and thick periosteal reaction.
 
MPVR CT reconstruction shows the presence of a gross expansive lesion involving the right femur proximal diaphysis.
 
T1-weighted MR image with fat suppression after Gadolinium i.v. injection demonstrates a lesion composed of juxtaposed hypocellular tissue, with mild-high contrast enhancement.
 
MRA MIP reconstruction coronal plane: vascular pedicles feeding the lesion from the right femoral artery.
 
MRA MIP reconstruction axial plane: vascular pedicles feeding the lesion from the right femoral artery.
 
Fusion PET-CT axial image shows high and heterogeneous 18F-FDG uptake by the neoplastic mass (SUV max.3.5).
 
Fusion PET-CT coronal image shows an 18F-FDG avid neoplastic mass.
 
Post-surgery digital radiography documents cadaveric femur transplantation and fibula autologous graft with multiple bone screws at the diaphysis of the right femur.
 
Post-surgery DSA image with superficial femoral and fibular pedicle arteries latero-lateral anastomosis.
 
3D shaded-surface rendering CT reconstruction highlites anatomical proximity of screws (red) and grafts.
 
Lesion exposure during surgical excision.
 
Gross specimen cut surfaces with solid inhomogeneous hypervascularised lesion. Poorly-defined intramedullary mass, extending through cortex with moth-eaten bone destruction and aggressive periostal reaction.
 
Gross specimen cut surfaces with solid inhomogeneous hypervascularised lesion. Poorly-defined intramedullary mass, extending through cortex with moth-eaten bone destruction and aggressive periostal reaction.
 
Lining cells of gland-like structure show irregular vesicular or optically clear nuclei with prominent basophilic nucleoli and occasional vacuolated cytoplasm. Epithelioid haemangioendothelioma morphology characterised by epithelioid endothelial cells.
 
The epithelioid histological subtype of haemangioendothelioma has epithelial-like cells lining the vascular channels that are large and cuboidal and contain abundant eosinophylic cytoplasm.
 
The epithelioid histological subtype of haemangioendothelioma has epithelial-like cells lining the vascular channels that are large and cuboidal and contain abundant eosinophylic cytoplasm.
 
Immunohistochemical study is helpful in confirming the diagnosis by identifying the markers for vascular endothelial cell (CD34+).
 
Immunohistochemical study is helpful in confirming the diagnosis by identifying the markers for vascular endothelial cell (CD34+).
 
 
 
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