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Age / Sex : 43 / F
43/F
C.C: 1. Palpable mass of left thigh for 3months 2. Back pain for 5years (Click to enlarge)
1) What is your impression of the abnormalities of pelvic bone and both femurs?
Courtesy : Sung Hye Koh, MD
Hallym University Sacred Heart Hospital
Diagnosis: tumor a/w osteomalacia (soft tissue mass: lipomatous hemangiopericytoma)
Discussion
Answer:
Tumor-associated osteomalacia (soft tissue mass: lipomatous hemangiopericytoma)
Findings:
1) Pelvis AP and left femur AP show post operative state of L5-S1, periarticular bone resorption and joint space widening of both S-I joints, widening and deformity of symphysis pubis, multiple subperiosteal bone resorptions of medial aspect of both femurs.
2) Longitudinal US image of left thigh mass show ill defined heterogenous hypoechoic mass with peripheral hyperechoic rim.
3) Pelvis MR images show an ovoid intramuscular mass of left sartorius muscle with heterogenous high signal intensity on transverse T2-weighted image and peripheral high signal intensity on transverse T1-weighted image, and heterogenous well enhancement on gadolinium-enhanced T1-weighted image. Differential Diagnosis: osteomalacia, osteoporosis
Discussion:
Hypophosphatemic vitamin D-refractory rickets and osteomalacia in association with various neoplasms have been recognized with increasing frequency. The associated neoplasms have occurred in children and adults, are located in soft tissues or bone, and vary in size. The most frequent histologic diagnosis has been hemangiopericytoma. Radiologic abnormalities of osteomalacia are subperiosteal bone resorptions. joint space widening (subchondral bone resorption and fibrosis). Osteosclerosis are noted frequently in uremic osteopathy. Hemangiopericytoma (HPC) is a tumor of adult. Two distinct clinical entities are present. Childhood hemangiopericytoma in children older than 1 year behaves in a similar manner to adult HPC. Infantile HPC is histologically identical but has a more benign clinical course. Slow, painless enlargement of a mass is the most frequent complaint, resulting in delayed diagnosis and treatment. US and MRI characteristics of hemangiopericytoma may be nonspecific.
References:
1. Pitt MJ. Rickets and osteomalacia. In Resnick D eds. Bone and joint imaging 2nd ed. Philadelphia: W.B. Saunders Company, 1996; 519-521.
2. Ramon F. Tumors and tumorlike lesions of blood vessels. In De Schepper AM, Parizel PM, De Beuckeleer L, Vanhoenacker F, eds. Imaging of soft tissue tumors. 2nd ed. Verlag Berln Heidelberg New York: Springer, 2001; 230-243.
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