PMC2698164_01
A 7-year-old boy with high grade hemangioendothelioma of the right temporal bone.. A. Plain radiograph shows a relatively well-defined osteolytic lesion in the right temporal bone (arrows).. B. Axial CT scan with bone window shows the marked bone destruction, with ill-defined margins, involving the mastoid portion of the right temporal bone.. C. Axial T1-weighted MR image (TR/TE, 509/14) reveals the main mass involving the right temporal bone with heterogeneous signal intensity and signal void dots (arrowheads).. D. Coronal T2-weighted image (TR/TE, 4225/100) shows temporal portion of the mass to be heterogeneously hypointense with multiple signal void dots (arrowheads), and the supratentorial portion to be homogenously hyperintense (arrows).. E. The coronal contrast-enhanced T1-weighted MR image (TR/TE, 509/14) reveals heterogeneous enhancement of the main mass in the temporal bone and peripheral enhancement of the intracranial portion (arrows).. F. Lateral view of the right external carotid angiogram shows a large, ill-defined hypervascular mass in the right temporal region, which is mainly supplied by petrosal branches of the middle meningeal artery (arrows).. G. The lesion still remained hypervascular on the late venous phase due to delayed washout of contrast media. Arteriovenous shunt was not demonstrated.. H. Photomicrograph shows the pleomorphic, highly atypical spindle cells with focal luminal differentiation filled with erythrocytes, and the irregular anastomosing vascular channels (arrows) (hematoxylin-eosin staining, x200).
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No evidence of sclerotic margin or periosteal reaction was found (Fig. 1A). Temporal bone CT revealed about a 5 cm sized, soft tissue density mass with marked bone destruction that mainly involved the mastoid portion of the right temporal bone (Fig. 1B). T1-weighted MR images (TR/TE, 509/14), the mass was heterogeneously hypointense with some high signal foci and signal void dots (Fig. 1C). The T2-weighted MR images (TR/TE, 4225/100) revealed a heterogeneous signal intensity mass with multiple signal void dots (Fig. 1D). After an intravenous infusion of contrast media, the main mass involving the temporal bone was intensely enhanced (Fig. 1E). The intracranial portion of the mass showed intermediate signal intensity on the T1-weighted images and homogenous high signal intensity on the T2-weighted images, and there was peripheral rim enhancement that represented necrosis (Fig. 1E). A large, ill-defined, hypervascular mass involving the right temporal region was seen on the early arterial phase of the external carotid arteriogram, and the mass was mainly supplied by petrosal branches of the middle meningeal artery (Fig. 1F). The lesion still remained hypervascular on the late venous phase of the arteriogram, and this was due to delayed washout of contrast media (Fig. 1G). The tumor showed focal luminal differentiation filled with erythrocytes (Fig. 1H).