PMC8600265_01
Digital radiograph preoperatively: (A,B) Radiographs of the right tibia and fibula showing an irregular bone destruction of proximal fibula; (C,D) 3d CT reconstruction demonstrating lytic bone destruction of right proximal fibula; (E,F) MRI revealing a massive vascular tumor with surrounding soft tissue hyperplasia and involvement of the proximal fibular epiphyseal plate.
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F1
Radiographs of the right tibia and fibula indicated an irregular bone destruction of proximal fibula (Figures 1A,B), and the lytic bone destruction was confirmed by 3d CT reconstruction (Figures 1C,D). MRI revealed a massive vascular tumor with surrounding soft tissue hyperplasia and involvement of the proximal fibular epiphyseal plate (Figures 1E,F).
The photograph during the surgery: (A) Intraoperative image of the surgical finding of a vascular mass attached to proximal fibula; (B) Complete curettage of lesion to normal fibular surface; (C) Macroscopic appearance of the excised lesion.
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F2
Gross examination showed a reddish spongious solid mass, containing topical hemorrhage, partial thrombosis, and irregular bone destruction (Figure 2A). With protection of common peroneal nerve and peripheral vessels, complete curettage of lesion was performed to normal periosteum of fibular (Figures 2B,C).
Histopathological features: (A) (HE, x40) the fissure-like vessel lumens lined with flattened endothelial cells among the spindle cells, (B) (HE, x100), (C) (HE, x200) the spindle shaped cells arranging in fascicular pattern in solid area. Immunohistochemical analysis revealing positive staining for (D) CD31 (x100), (E) CD34 (x100), and (F) ERG (x100) in the majority of spindle cells.
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F3
Histologically, the lesion was characterized by the fissure-like vessel lumens lined with flattened endothelial cells among the spindle cells (Figure 3A). The spindle-shaped cells arranged in fascicular pattern in solid area, with similar cell morphology and no atypia (Figures 3B,C). Immunohistochemically, the endothelial cells lining the vessel spaces stained positive for CD31, CD34, and ERG (Figures 3D-F).
Digital radiograph at 2 years postoperatively: (A,B) Radiographs showing reformation of the cortex of the proximal fibula; (C,D) 3d CT reconstruction demonstrating both uniform bone mineral density and continuous cortical of right proximal fibula; (E,F) MRI revealing remarkable regression of lesion without evidence of local recurrence.
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F4
Radiographs showed the reformation of the cortex of the proximal fibula (Figures 4A,B), and both uniform bone mineral density and continuous cortical of right proximal fibula were confirmed by 3d CT reconstruction (Figures 4C,D). Besides, MRI demonstrated remarkable regression of lesion without any signs of tumor growth through the fibula (Figures 4E,F).