PMC8311747_01
(A) Gross appearance of the mass at anteromedial aspect of the leg and previous biopsy scar. (B) Anteroposterior and lateral radiographs of the tibia. (C) Axial. (D) Coronal. (E) Sagittal T2-weighted images showing high-intensity signal lobules with striations extending from proximal epiphyseal border to distal tibia with soft tissue expansion
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F1
There were no other masses (Fig. 1A). There was a lattice-like pattern with horizontally and vertically oriented striations within the entire lesion (Fig. 1B). Magnetic resonance T2-weighted images showed multiple high signal intensity lobules with multiple septations containing several round areas of low signal intensity (Figs 1C to E).
(A) Resection of tibia. (B) Resected mass measuring 24 cm in length and 12 cm in maximum diameter
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F2
Distally, the tibia was cut 1 cm beyond the intramedullary extent of the tumour, leaving 3 cm of distal tibia (Fig. 2A). The entire resected specimen measured 24 cm in length and 12 cm in maximum diameter (Fig. 2B).
(A) Anteroposterior. (B) Lateral views of the leg showing Ilizarov construct and the olive wires at the fibula. (C) Follow-up radiographs show callus formation at graft-host junction
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F3
The fibula was percutaneously osteotomised at two levels corresponding to the cuts of the remaining portions of the proximal and distal tibia (Figs 3A to C).
Radiographs at 38 months after surgery showing union at proximal and distal graft-host site with fibular hypertrophy
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F4
At 6 months, radiographs showed healing at both distal and proximal ends (Fig. 4). Radiographs at 38 months showed union at proximal and distal graft-host sites with fibular hypertrophy (Fig. 4).
Patient at 38 months postoperative, with flexion up to 100
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F5
At review, the patient has no pain, has full knee extension and has up to 100  of knee flexion (Fig. 5).