PMC6336654_01
Images of the third lumbar vertebra. The radiographs of the lumbar vertebrae with anteroposterior projection A and lateral projection B reveal that the lesion is located in the third lumbar vertebra and presents with typical vertical vertebral striation due to the thickened trabeculae. The vertebral body exhibits decreased density with slight bone expansion. C, An axial CT image demonstrating the classical "polka-dot" appearance and vertically oriented vertebral lucency separated by thickened trabecular bone. D, An axial T2-weighted sequence MR image revealing a heterogeneous, high-signal-intensity lesion with multiple punctate areas that resemble the "polka dot" sign. E and F, Sagittal MR images of T1-weighted and T2-weighted sequences. The lesion has low signal intensity on T1-weighted SE and high signal intensity on T2-weighted SE MR images. Both sequences reveal slight dural sac compression. CT = computed tomography.
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F1
The X-ray obtained in our hospital revealed a "fence" change at her third lumbar vertebra (Fig. 1). CT images revealed bone destruction in the 2 affected ribs, with a soft tissue mass with well-defined margins and expansile lesions in the right ilium and pubis, respectively (Figs. 3 and 4). CT examination of the lumbar vertebrae revealed a "polka-dot" sign with a slight compression fracture of the third lumbar vertebra (Fig. 1). On magnetic resonance imaging (MRI), the lumbar lesion presented with long T1 and T2 signals and extended into the spinal canal (Fig. 1).
A bone scan of the patient revealing multifocal involvement, including involvement of the bilateral ribs; third lumbar vertebra; and right ilium, pubis, and proximal femur; with increased isotope uptake.
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F2
A bone scan revealed multi-bone nuclide uptake, including uptake in the bilateral ribs, third lumbar vertebra, and right ilium, pubis, and proximal femur (Fig. 2).
CT images of the chest. A and B, An axial soft tissue window CT image revealing a bony lesion with a well-defined expansile soft tissue component in the bilateral ribs. C and D, An axial bone window CT image showing a combination of trabeculation and matrix ossification within both the intramedullary component and the extraosseous extension in the bilateral ribs. CT = computed tomography.
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F3
CT images revealed bone destruction in the 2 affected ribs, with a soft tissue mass with well-defined margins and expansile lesions in the right ilium and pubis, respectively (Figs. 3 and 4). CT examination of the lumbar vertebrae revealed a "polka-dot" sign with a slight compression fracture of the third lumbar vertebra (Fig. 1).
Images of the pelvis and proximal femur. A, An AP radiograph of the pelvis and proximal femur revealing a lytic lobular lesion with sclerotic margin in the right ilium, an expansile lobular lytic lesion in the right pubis, and a lobular lesion with sclerotic margins in the right femur. B, A coronal CT image demonstrating a lobular lesion with focal cortical destruction and extensive internal matrix ossification in the right ilium and a lobular lesion with intramedullary matrix ossification in the right proximal femur. C, A coronal CT image showing a combination of trabeculation and matrix ossification within the right pubis intramedullary and punctate calcification in the extraosseous extension with a well-defined margin. CT = computed tomography.
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F4
CT images revealed bone destruction in the 2 affected ribs, with a soft tissue mass with well-defined margins and expansile lesions in the right ilium and pubis, respectively (Figs. 3 and 4). CT examination of the lumbar vertebrae revealed a "polka-dot" sign with a slight compression fracture of the third lumbar vertebra (Fig. 1).
Microscopic pathological images of the patient. A, Hematoxylin-eosin staining at low magnification (x40) and B, high magnification (x200) revealing the proliferation of capillary-sized vessels in the osseous tissue. Cytologic atypia is not apparent.
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F5
An intraosseous hemangioma with a typical pathological appearance was pathologically confirmed (Fig. 5).