PMC4719350_01
A seven month old infant presented with X-ray of left tibia showed an expansile osteolytic and poorly demarcated lesion involving the metaphyseo-diaphyseal region of left upper tibia with no periosteal reaction.
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F1
X-ray of left tibia showed an expansile osteolytic and poorly demarcated lesion involving the metaphyseo-diaphyseal region of left upper tibia (Fig 1).
MRI of left tibia showed relatively well delineated expansile metadiaphyseal intramedullary lesion in the proximal and mid tibia with marked cortical thinning and suspicion of cortical breach.
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F2
Surrounding periosteal thickening was seen with edematous changes (Fig 2).
Histology of the lesion showing inter anastomosing capillary sized vessels lined by polygonal cells. (H&E, 40X)
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F3
Microscopic examination of sections from bone showed a vascular neoplasm composed of interanastomosing capillary sized vessels(Fig 3).
Immunoistochemistry showing CD34 positivity by tumour cells(40X)
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F4
The tumor was immunoreactive for factor CD34 and vimentin (Fig 4).
Sequential Radiographs show progressive regression of the lesion. Radiographs (from left to right) 6 montinone year and two year follow tip
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F5
The lesion showed a dramatic response by spontaneous regression during this period (Fig 5) and by the end of 1 1/2 years the lesion almost healed (Fig. 5).