PMC4615364_01
Imaging studies for 45-year-old patient ("Case 1") with pseudomyogenic hemangioendothelioma. a Baseline fat saturated T1-weighted axial magnetic resonance image with intravenous contrast enhancement of the pelvis demonstrates multiple enhancing tumor foci in the right iliac bone (white arrow). b Positron emission tomography-computed tomography (PET-CT) fusion image through the pelvis demonstrates diffuse metabolic activity in the right anterior iliac bone (disease in the right posterior iliac bone at the level of the sacroiliac joint was also present but is not shown). This image was obtained 1 month before the patient began gemcitabine/docetaxel. c PET-CT fusion image through the pelvis after three cycles of gemcitabine/docetaxel demonstrates a significant metabolic response
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Fig1
Restaging PET-CT studies performed after completion of the third cycle revealed that the PMH had significantly responded to gemcitabine plus docetaxel (Fig. 1).
PMC4615364_02
Baseline magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) studies for a 22-year-old man ("Case 2") with pseudomyogenic hemangioendothelioma. a Baseline contrast-enhanced, fat-saturated T1-weighted axial MR image of the right thigh demonstrates multifocal enhancing lesions in the distal femoral metadiaphysis (short white arrow) and vastus intermedius muscle and subcutaneous fat. b PET-CT fusion image through the distal femurs demonstrates corresponding hypermetabolic activity. Restaging examinations after two cycles of gemcitabine and docetaxel (not shown) did not demonstrate any significant response
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Fig2
A baseline PET-CT study revealed a hypermetabolic mass in the right distal femur (standardized uptake value, maximum of 15.2) and a 1.3 cm left acetabular lytic lesion (standardized uptake value, maximum of 7.9), suspicious for metastatic disease (Fig. 2).
Imaging studies obtained during treatment for a 22-year-old man ("Case 2") with pseudomyogenic hemangioendothelioma. a Fat-saturated T1-weighted axial magnetic resonance image with intravenous contrast enhancement of the pelvis demonstrates a solitary enhancing tumor focus in the supra-acetabular region of the left iliac bone (white arrow), before everolimus treatment. b Positron emission tomography-computed tomography fusion image through the pelvis demonstrates corresponding metabolic activity. This image was obtained before the patient began everolimus treatment. c Fat-saturated T1-weighted axial MR image with intravenous contrast enhancement of the pelvis obtained after 2 months of everolimus demonstrates partial response of the solitary enhancing tumor focus in the supra-acetabular region of the left iliac bone
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Fig3
TSC1 mutation, therapy with everolimus (10 mg/day) was started. Two months later, the patient underwent MRI of the pelvis, which revealed mild interval healing of the small intramedullary metastases in the supra-acetabular region of the left iliac bone (Fig. 3).