title: A novel treatment for bone lesions of multifocal epithelioid sarcoma-like hemangioendothelioma.
abstract: Epithelioid sarcoma-like hemangioendothelioma (ES-H) is a rare, indolent vascular neoplasm with characteristics similar to epithelioid sarcoma. It typically affects young males who present with skin and subcutaneous lesions in the extremities. Bone lesions, occurring in approximately 20% of patients, are often multifocal, seen in conjunction with soft tissue lesions, and usually found in bones of the lower extremities. This report details the case of a 20-year-old male who presented with a 1-year history of painful skin lesions on his left lower extremity. Staging studies revealed bone lesions in the cuboid and calcaneus. Bone and soft tissue pathology was consistent with ES-H. The soft tissue lesions were treated with wide excision and the bony lesions with radiofrequency ablation (RFA). The patient had no evidence of recurrence at the 2-year follow-up. Treatment of ES-H typically consists of wide excision of all soft tissue lesions and possible adjuvant radiation therapy. Management of bony lesions has included marginal excision, wide excision, amputation, chemotherapy, observation, or a combination of these modalities. ES-H has the potential for distant metastases. There is no consensus regarding the appropriate treatment of multifocal epithelioid sarcoma-like hemangioendothelioma involving bone. A potential treatment strategy of wide excision of soft tissue lesions and RFA of bone lesions is proposed.
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University, 3635 Vista Avenue, 7th floor, St. Louis, MO, 63110, USA, adtdavis@gmail.com.
authors.forename: Adrian T
authors.initials: AT
authors.lastname: Davis
authors.forename: A Mary
authors.initials: AM
authors.lastname: Guo
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Phillips
authors.forename: David D
authors.initials: DD
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005534:Foot Diseases / Q000175:diagnosis / Q000601:surgery*; D018323:Hemangioendothelioma, Epithelioid / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012509:Sarcoma / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome