case_images: PMC10423994_01
case_images: PMC10423994_02
case_images: A pelvic x-ray when the patient was 66 years old presents the dislocation of the right hip and the left total hip arthroplasty after acetabular revision. The acetabular cup is augmented with cement and titanium mesh.
case_images: fsurg-10-1212491-g001.jpg
case_images: PMC10423994_04_fsurg-10-1212491-g001.jpg
case_images: F1
case_images: They showed dense connective tissue, some macrophages pigmented with foreign material (likely metal), and necrotic debris, suggesting an inflammatory reaction but neither infection nor malignancy (Supplementary Figure S1).
case_images: PMC10423994_03
case_images: (A) A chest CT scan when the patient was 71 years old showed pleural fluid, suggesting empyema. On the right side, the pleura is thickened at the mediastinum and the interlobular septa, suggesting malignancy (arrows). (B) At the same time, an abdominal CT scan showed a mass, which was presumed to be a total hip arthroplasty (THA)-associated pseudotumor (arrows). (C) When the patient was 74 years old, upon hospital admission, a body CT scan showed ground-glass opacity areas in the lungs (arrow) and (D) enlargement of the THA-associated pelvic mass (size: 6 cm x 7.5 cm x 9 cm; arrows). Metal artifact-reducing sequence magnetic resonance imaging (MARS-MRI) showed an enlarged THA-associated mass in multiple locations: (E) the iliopsoas region (7.1 cm x 6.6 cm x 8.9 cm, arrows), (F) posteromedial to the acetabulum (4.7 cm x 4.8 cm x 8.8 cm, arrows), and (G) near the trochanter major (4.1 cm x 2.1 cm x 6.4 cm, arrows). (H) A preoperative pelvic CT scan showed remarkable osteolysis of the pubic and acetabular regions (arrows).
case_images: fsurg-10-1212491-g002.jpg
case_images: PMC10423994_04_fsurg-10-1212491-g002.jpg
case_images: F2
case_images: A body CT (including pulmonary angiography) scan showed small areas of ground-glass opacity, predominantly on the right side of the patient (Figure 2C). Her abdominal CT scan showed growth of the suspected pseudotumor (to 6 cm x 7.5 cm x 9 cm, Figure 2D) and fractures of the pubic bone and trochanter major. THA and suspected pseudotumor showed significant growth of the mass in multiple locations, namely, the iliopsoas region (7.1 cm x 6.6 cm x 8.9 cm, Figure 2E), posteromedial to the acetabulum (4.7 cm x 4.8 cm x 8.8 cm, Figure 2F), and near the fractured trochanter major (4.1 cm x 2.1 cm x 6.4 cm, Figure 2G). The blood metal ion levels of the patient were not increased [cobalt (Co) level was below 0.9 microg/L, and Cr level was below 0.6 microg/L].
case_images: PMC10423994_04
case_images: A pelvic x-ray when the patient was 66 years old presents the dislocation of the right hip and the left total hip arthroplasty after acetabular revision. The acetabular cup is augmented with cement and titanium mesh.
case_images: fsurg-10-1212491-g001.jpg
case_images: PMC10423994_04_fsurg-10-1212491-g001.jpg
case_images: F1
case_images: They showed dense connective tissue, some macrophages pigmented with foreign material (likely metal), and necrotic debris, suggesting an inflammatory reaction but neither infection nor malignancy (Supplementary Figure S1).
case_images: (A) A chest CT scan when the patient was 71 years old showed pleural fluid, suggesting empyema. On the right side, the pleura is thickened at the mediastinum and the interlobular septa, suggesting malignancy (arrows). (B) At the same time, an abdominal CT scan showed a mass, which was presumed to be a total hip arthroplasty (THA)-associated pseudotumor (arrows). (C) When the patient was 74 years old, upon hospital admission, a body CT scan showed ground-glass opacity areas in the lungs (arrow) and (D) enlargement of the THA-associated pelvic mass (size: 6 cm x 7.5 cm x 9 cm; arrows). Metal artifact-reducing sequence magnetic resonance imaging (MARS-MRI) showed an enlarged THA-associated mass in multiple locations: (E) the iliopsoas region (7.1 cm x 6.6 cm x 8.9 cm, arrows), (F) posteromedial to the acetabulum (4.7 cm x 4.8 cm x 8.8 cm, arrows), and (G) near the trochanter major (4.1 cm x 2.1 cm x 6.4 cm, arrows). (H) A preoperative pelvic CT scan showed remarkable osteolysis of the pubic and acetabular regions (arrows).
case_images: fsurg-10-1212491-g002.jpg
case_images: PMC10423994_04_fsurg-10-1212491-g002.jpg
case_images: F2
case_images: A body CT (including pulmonary angiography) scan showed small areas of ground-glass opacity, predominantly on the right side of the patient (Figure 2C). Her abdominal CT scan showed growth of the suspected pseudotumor (to 6 cm x 7.5 cm x 9 cm, Figure 2D) and fractures of the pubic bone and trochanter major. THA and suspected pseudotumor showed significant growth of the mass in multiple locations, namely, the iliopsoas region (7.1 cm x 6.6 cm x 8.9 cm, Figure 2E), posteromedial to the acetabulum (4.7 cm x 4.8 cm x 8.8 cm, Figure 2F), and near the fractured trochanter major (4.1 cm x 2.1 cm x 6.4 cm, Figure 2G). The blood metal ion levels of the patient were not increased [cobalt (Co) level was below 0.9 microg/L, and Cr level was below 0.6 microg/L].
case_images: (A) Hematoxylin-eosin staining (HE) of autopsy specimens from the THA-associated mass shows a focal, patchy, atypical endothelial cell proliferation. (B) The atypical endothelial cell proliferation of the THA-associated mass is highlighted by CD31-positive cells by immunohistochemistry (IHC). (C) HE staining of autopsy specimens from the lungs shows atypical endothelial cell proliferation. (D) The atypical endothelial cell proliferation of the lungs is shown as CD31-positive cells by IHC. (E) HE staining of autopsy specimens from bone marrow shows atypical endothelial cell proliferation. (F) The atypical endothelial cell proliferation of the bone marrow is shown as CD31-positive cells by IHC. These findings are diagnostic of angiosarcoma. Scale bar 0.5 mm.
case_images: fsurg-10-1212491-g003.jpg
case_images: PMC10423994_04_fsurg-10-1212491-g003.jpg
case_images: F3