PMC3180772_01
X-rays (anterior view) of the left tibia and foot show osteolytic lesion causing irregular cortical bone in the cuboid bone, distal tibia and fibular head with a surrounding slight soft tissue swelling (arrow).
ijmsv08p0558g01.jpg
PMC3180772_01_ijmsv08p0558g01.jpg
F1
Radiographs showed a lytic lesion causing irregular cortical bone thinning in the body of the upper fibula with a surrounding slight soft tissue swelling (Figure 1 A). Then we made further both lower extremities X-ray examination, found the similar osteolytic lesion in the distal tibia and cuboid bone (Figure 1 B,C).
Presurgical MRI examinations. A: MRI showed intramedullary solid lesion covering the distal tibia bone without breaking articular surfaces. T2 weighted image showed the lesion as a high signal (arrow). B: MRI manifested multiple independent solid lesions in the gastrocnemius muscle at the level of the head of the fibula and multifocal lesion with irregular borders at the upper fibula (arrow). C:MRI examination of left lower leg revealed the occult lesions of calcaneus close to the calcaneal tubercle (arrow).
ijmsv08p0558g02.jpg
PMC3180772_01_ijmsv08p0558g02.jpg
F2
However, magnetic resonance image (MRI) for left lower extremity manifested multiple solid lesions in the gastrocnemius muscle at the level of the head of the fibula and multifocal lesion with irregular borders at the upper fibula, distal tibia, cuboid bone and calcaneus (Figure 2).
The lesions compose of vascular structures of different caliber lined with mild atypical endothelial cells. Histopathological picture consistent with EH (HE X100).
ijmsv08p0558g03.jpg
PMC3180772_01_ijmsv08p0558g03.jpg
F3
The epithelioid cytomorphology were polygonal or spindle shaped, which had vesicular nuclei, unapparent nucleoli and eosinophilic cytoplasm with intractyloplasmic vacuoles and were easily identified (Figure 3).