case_images: PMC11705994_01
case_images: (A) X-ray pelvis AP view: geographic lytic insufflating expansive lesion centered in the intertrochanteric region of the left femur that destroys the cortex with poorly defined borders in certain locations. Soft tissue mass associated. The tumor matrix shows thin septum reaching 9 cm in longitudinal axis. (B) Axial CT: lytic lesion with cortical destruction at trochanteric level.
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case_images: The radiological image showed an osteolytic lesion that had destroyed the intertrochanteric region of the left femur (Fig. 1A). A computed tomography (CT) was performed and showed the femur lesion with an associated soft tissue mass (Fig. 1B).
case_images: Bone scintigraphy of the entire skeleton with Tc99 and SPECT-CT. Highlighting of radioactive tracer in left proximal femur and sacrococcygeal region.
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case_images: (A) T2 sequence with fat saturation and (B) T1-weighted sequence in axial plane centered on the left hip: a large expansive lesion is visualized centered in the trochanteric region extending to the femoral neck with a heterogeneous matrix of hyperintense predominance with respect to the muscle in both sequences in which cavities with liquid/liquid levels are identified (arrow) compatible with bleeding in different phases. The anterior cortex is focally rotated extending to the medial gluteal musculature (arrow). (C) Coronal section in STIR sequence showing sacrococcygeal involvement of the same characteristics as the femoral lesion. (D) Coronal section in STIR sequence centered in the gluteal region: an elongated lesion with lobulated borders is seen extending from the lateral region of the gluteus maximus to the proximity of the sacrococcygeal region (arrow). It coincides with the biopsy trajectory and is suggestive of tumor seeding.
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case_images: Wide intra-articular tumor resection of the proximal femur and reconstruction with tumor prosthesis and bipolar head.
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case_images: f4
case_images: 15 cm long of (A) anterior and (B) posterior gross views of the proximal femoral resection with a lateral soft tissue mass. (C) Lateral metaphysis-diaphyseal tumor with soft tissue extension, composed by bloody multiloculated cavities. (D) Epithelioid cells forming vascular channels with marked atypia (H&E x400). (E) ERG (ERG x400).
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case_images: f5
case_images: No macroscopic tumoral invasion of surgical margin was observed (Fig. 5A-C). The diagnosis of epithelioid angiosarcoma of bone was confirmed (Fig. 5D and E).
case_images: (A) PET-CT: 10 mm nodule in the left pulmonary apex with incipient metabolic activity suggestive of malignancy (arrow). (B, C) MRI: deep residual lesional focus in the anterolateral region dependent on the anterior rectus muscle (arrow).
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case_images: f6