Weekly Case

Title : Case 919

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



Correct Answer
Total applicants 19 Correct answers 2
Name Institution
윤정택 전공의
도윤아 전문의
Semi-Correct Answer
Total applicants 19 Semi-Correct answers 4
조서범 전공의
곽경수 전문의
전차웅 가톨릭대학교 여의도성모병원, 전공의
박영태 전문의


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