Case report 521: Histiocytoid hemangioma of the distal end of the right humerus

The Disappearing Phalanx: A Case Report of a Vascular Tumor of the Toe

We report a unique case of an epithelioid hemangioma of the third middle phalanx in which the lesion replaced the phalanx, became symptomatic, and then required resection, bone grafting, and joint arthroplasty. To the best of our knowledge, this is the first report of an epithelioid hemangioma in the toe that was treated using this approach.

Epithelioid hemangioendothelioma of the proximal phalanx of the left second toe - a rare occurence

INTRODUCTION

Epithelioid hemangioendothelioma (EHE) of the bone is extremely rare and occurs predominantly in males. It most frequently occurs during the second and third decades of life. The lower extremities are most commonly involved. We describe a diagnostically challenging case of epithelioid hemangioendothelioma of proximal phalanx of 2nd toe of left foot with histological features reminiscent of osteoblastomatosis.

CASE REPORT

A 52 year old man presented with history of intermittent pain with swelling in second toe since 6 months. Radiograph showed a lytic lesion in proximal phalanx of the great toe. CT and MRI reported non specific lesion in the toe. Pain was quite severe and as the patient was a labourer and wanted to get back to his work as soon as possible a decision of disarticulation of the second toe at metatarsophalnageal joint was taken. Histopathology confirmed the diagnosis of Epithelioid hemangioendothelioma and patient was called for regular follow up. There are no complications and recurrence at two year follow up.

CONCLUSION

EHE of the bone is extremely rare vascular tumor. To our knowledge, this is the first case of EHE with such features. EHE should be kept as one of the important differential diagnosis while diagnosing vascular tumors. Careful attention to the histopathological features is necessary for the confirmation of the diagnosis.

"Soap Bubble" Lesion of the Middle Phalanx: Enchondroma or Epitheloid Hemangioma

Introduction:

Epitheloid hemangioma, a benign vascular tumor that arises in skin and soft tissues can also involve the skeletal system. Occasionally this has been reported from small tubular bones of the hand.

Case Report:

Authors report a case of epitheloid hemangioma of the middle phalanx in a young girl without any cutaneous manifestations. The lesion presented as a swollen middle finger, and plain radiographs showed a geographic area of destruction with cortical thinning and intra lesional calcifications. The case was managed by curettage and bone grafting. Histology confirmed this as a case of epitheloid hemangioma.

Conclusion:

Epitheloid hemangioma should be considered in the differential diagnosis of hand masses with expansile lytic lesions with cortical thinning.

Epithelioid hemangioma of the distal humerus with pathologic fracture

Epithelioid hemangioma is a rare tumor that can have bone involvement. Its clinically and radiographically aggressive appearance mimics a malignant neoplasm. Although epitheliod hemangioma has been described as having an aggressive appearance on magnetic resonance imaging (MRI) and plain radiographs, this is the first reported case of pathologic fracture associated with this lesion to our knowledge. This article describes a case of epithelioid hemangioma involving the distal humerus, which initially presented with progressive pain and fracture of the lateral condyle. The aggressive appearance on plain radiographs and MRI suggested a malignant bone tumor. This preliminary diagnosis was confirmed due to the presence of local lymph node spread on positron emission tomography/computed tomography. After a core needle biopsy revealed nondiagnostic tissue, rather than performing a wide resection based on a presumptive malignant diagnosis, we followed the standard diagnostic algorithm and performed an open biopsy with temporary internal stabilization. The tissue sample was adequate and revealed a diagnosis of epithelioid hemangioma. Based on this finding, we were able to proceed with surgical management, including curettage of the lesion, placement of a bone graft, and internal fixation, rather than a wide resection with elbow joint replacement. This article emphasizes the need for careful adherence to the diagnostic algorithm for musculoskeletal tumors. In doing so, a definitive diagnosis was reached, and our patient was able to resume his occupation as a laborer without the restrictions that would have accompanied elbow arthroplasty.

Case report 671: Arteriovenous malformation of the right lower extremity with associated intraosseous hemangiomatosis

Since extensive involvement of the lower extremity with arteriovenous malformations occurs often combined with the potential risk of hemorrhage, transcatheter embolization has become an attractive alternative to surgical resection [7, 9]. We describe an unusual case of extensive intraosseous hemangiomatosis, with a concomitant arteriovenous malformation that presented in a 35-year-old woman as synovitis in a knee. MR images demonstrated that the lesion was far more extensive than originally suggested and directed the subsequent biopsy and embolization. The differential diagnosis was discussed and the subject of intraosseous hemangiomatosis with associated AVM was considered in some detail.