PMC5384294_01
Plain radiograph showing periosteal reaction with cortical hypertrophy of the posterior mid-diaphyseal segment of the right tibia (white arrow).
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Soft tissue abnormalities were not identified within the tibia, and the visualized knee and ankle joints appeared normal (Fig. 1).
Axial CT scan revealed a cortically based sclerotic lesion emanating from the posterior aspect of the tibial diaphysis (white arrow). A poorly defined high density heterogeneous mass was seen immediately posterior to the cortically based lesion, within the adjacent musculature, likely representing a phlebolith (red circle).
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There was no identifiable cortical breakthrough (Fig. 2).
A large friable soft lobulated dark-red mass was located on the surface of the hypertrophic tibia bone and interpolated within the soleus muscle fibers. Photographs showed the tumorous mass before (A) and after (B) surgical excision. (C) Plain radiograph showing en-bloc excision of the hypertrophic cortex of the posterior mid-diaphyseal segment of the right tibia.
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A large friable soft, lobulated mass, measuring 10 cm x 4 cm x 2 cm in length, wide and thickness respectively, was located on the surface of the tibial bone, interpolated within the soleus muscle fibers, and eroding the tibial cortex without evidence of intramedullary involvement (Fig. 3A). The thickened cortex was excised en-bloc with the adjacent soft tumorous mass (Fig. 3B and C).
Microscopically (hematoxylin-eosin, magnification 100x), red blood cells are visible within multiple dilated vascular channels (A) with interpositions of fibrous stroma and surrounded by skeletal muscle. The lining endothelial cells are stained for factor VIII (B). No nidus was found.
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Histology revealed poorly circumscribed dilated vascular channels in a loose fibrous stroma interspersed between striated muscle bundles (Fig. 4A). The presence of cells that stained positively for factor VIII confirmed the diagnosis of intramuscular cavernous hemangioma (Fig. 4B).