PMC4895778_01
Preoperative oblique radiograph of the right distal forearm demonstrating an epithelioid hemangioendothelioma. A lytic, septated, expansile lesion is present without identifiable matrix. A pathologic fracture is visible along the radial border.
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Plain radiographs demonstrated an expansile lesion within the distal one-third of the radius (Figure 1).
Sagittal (A) and axial (B) T1-weighted fat suppressed MR images with gadolinium enhancement demonstrate a heterogeneously enhancing, aggressive lesion that traverses the bone cortex and is encased by the pronator quadratus and brachioradialis muscles.
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The lesion demonstrated a heterogeneously enhancing, aggressive-appearing lesion (Figure 2).
Hematoxylin and eosin stain of the high grade epithelioid hemangioendothelioma. Note is made of epithelioid neoplastic cells with prominent nuclei and nucleoli lining the vascular spaces, with eosinophilic and amphophilic cytoplasms. Focal myxoid or chondroid-like matrix is present. A: Vasoformative channels. B: Cytologic atypia, the nuclei are plump, hyperchromatic, variable in shape, and may bulge into the vascular lumina. C: Collagenized, chondroid appearing stroma.
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The tumor cells, in general, were uniform and round with some spindle shaped and some with endothelial differentiation demonstrated by intracytoplasmic lumina that could be seen as vacuoles (Figure 3).
CT scan obtained 9 months postoperatively. The distal aspect of the graft is well incorporated. The proximal aspect demonstrates partial incorporation with ingrowth into the medullary canal and incomplete callus formation at the periphery. Heterotopic ossification is seen adjacent to the plate.
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CT scan of the extremity demonstrated union at nine-months postoperatively of both the proximal and distal portions (Figure 4).