Age / Sex : 46 / F
C.C : palpable mass
What is your diagnosis?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)
Courtesy : 이선주 (Sun Joo Lee), 부산백병원 (Inje University Busan Paik Hospital)
Diagnosis: Intravascular papillary endothelial hyperplasia (IPEH)
Discussion
Findings X-ray: soft tissue swelling in lateral aspect of elbow without calcification US Well-defined heterogeneously hypoechoic mass with hyperechoic septa and central portion with intratumoral & peripheral increased vascularity in extensor carpi radialis longus and brevis muscle MRI well-defined heterogeneous enhancing lesion in extensor carpi radialis longus and brevis muscle around left elbow, showing internal low signal intensity foci on T2WI and internal high signal intensity foci on T1WI
Rare benign vascular lesion (2-4%) Reactive papillary endothelial proliferation within vessels and close association with thrombus - Specific form of thrombus organization rather than primary structure
Clinical presentation 1. slowly growing palpable lesion - Often bluish or reddish discoloration of overlying skin or pain 2. TOC - complete surgical excision 3. Recurrence - 10% more common in mixed form
Divide into 3 forms 1. Primary or pure form - Arise in dilated vascular spaces (m/c in finger) 2. Mixed form - Occur in pre-existing vascular abnormalities such as hemangioma, AVM, pyogenic granuloma - No predilection for location 3. Extravascular form - Arise in hematoma (rare)
References 1. Skeletal Radiol (2010) 39:783–789 2. Skeletal Radiol (2016) 45:1467–1472 3. Skeletal Radiol (2016) 45:227–233 4. AJR 2016; 206:952–962
|