title: Hemangioendothelioma with an epithelioid phenotype arising in hemangioma of the fibula.
abstract: The classification of certain vascular bone tumors that show an epithelioid cytologic appearance remains confusing, with overlap in features of epithelioid hemangioma, hemangioendothelioma and epithelioid hemangioendothelioma. Radiographs of a 27-year-old woman who presented with ankle pain showed an expanded lytic-sclerotic lesion in the distal left fibula. Magnetic resonance imaging showed an intramedullary lesion with a small lateral intracortical component. The lesion was hypo- to isointense to muscle on T1-weighted images and heterogeneously hyperintense on T2-weighted images. Initial incisional biopsy was inconclusive. Open biopsy showed hemangioendothelioma with epithelioid morphology, and the lesion was completely resected with reconstruction using a peroneal fibular rotation graft. Examination of the resected specimen showed focal hemangioendothelioma with an epithelioid phenotype arising in a hemangioma. This case illustrates the difficulty and pitfalls of making the correct diagnosis on the basis of a small biopsy specimen.
authors.affiliation: Department of Diagnostic Radiology, Changi General Hospital, Singapore.
authors.forename: Zarine K
authors.initials: ZK
authors.lastname: Shah
authors.forename: Wilfred C G
authors.initials: WC
authors.lastname: Peh
authors.forename: Tony W H
authors.initials: TW
authors.lastname: Shek
authors.forename: Jimmy W K
authors.initials: JW
authors.lastname: Wong
authors.forename: Eric P
authors.initials: EP
authors.lastname: Chien
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D001859:Bone Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000473:pathology*; D018323:Hemangioendothelioma, Epithelioid / Q000175:diagnosis*; D006391:Hemangioma / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis*; D011859:Radiography