PMC3247783_01
Radiological images of the patient. (A) Multiple, small and elongated osteolytic lesions with thin sclerotic rims are noted in the both femoral necks (arrows). Both knee AP (B) and lateral views (C, D) show small, eccentric osteolytic lesions involving right proximal fibula and left proximal fibula (white arrows). Large amount of suprapatellar effusions are also noted in the both sides of knee (black lined white arrows). Both ankle AP (E) and right lateral views (F) show well-defined osteolytic lesions with thin sclerotic rim involving right distal fibula (white arrows) and left distal tibia (black lined white arrows).
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F1
In the plain radiographies, the osteolytic lesions surrounded by a thin sclerotic rim were noted on the both femoral necks, both proximal fibula, right distal fibula, and left distal tibia (Fig. 1).
MR scan images of low extremity. Contrast enhancement T1-weighted axial (A) and sagittal scans (B) with fat-suppression show diffuse synovial enhancement (white arrows) and tenosynovitis (black lined white arrows) around right ankle joint. Abnormal enhancement lesion is also noted in the right 2nd metatarsal shaft (black arrow). Contrast enhancement T1-weighted sagittal scans (C) with fat-suppression show joint effusion with diffuse synovial enhancement (white arrow) in the left tibia MR scans.
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F2
In addition, there were signal intensity alterations on the distal femur, proximal/distal fibula, proximal/distal tibia, as well as 2nd metatarsal bone, 2nd to 4th proximal phalanges, and tarsal bones (Fig. 2).
The whole body bone scan showed no definite abnormal focal bony uptake lesions except mildly increased soft tissue uptake on the bilateral suprapatellar bursa area (arrows).
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F3
The whole body bone scan showed no definite abnormal focal uptakes except mildly increased soft tissue uptake on the bilateral suprapatellar bursa area (Fig. 3).
PET/CT images. (A) Whole body MIP (maximum intensity projection) image. (B) Regional images demonstrating hypermetabolic activity in nasopharynx, bilateral tonsils and cervical lymph nodes. (C) Mid abdominal lymph nodes. (D) Thickened synovial lining of both knee joints.
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F4
In addition, hypermetabolic lymph nodes were also noted in bilateral cervical, parapharyngeal, and mid-abdominal area as well as palatine tonsils (Fig. 4).
Histopathological findings of the biopsied tissue. Non-caseating, sarcoidal, chronic granulomatous inflammation is observed in the skin rash (A) and subcutaneous nodule, and synovium of knee joint (B, C). However, the pathological finding of right tibia is compatible with enchondroma (D). (H&E stained, A x 200; B, x 100; C and D, x 200).
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F5
However, the pathologic finding of right tibia was compatible with enchondroma (Fig. 5).