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Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 2: A 30-year-old woman had pain in her leg for six months.
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Question 1 of 1
1. Question
Week 199: Case 2
A 30-year-old woman had pain in her leg for six months. A radiograph demonstrated an aggressive destructive lytic lesion occupying the midshaft of the femur. A biopsy was performed./images/EMC 2 Image2.jpg
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/images/emc 2 p9031983.jpgCorrect
Answer: Epithelioid hemangioendothelioma
Histology: The lesion is a vascular neoplasm in which the principle cell is a rounded epithelioid cell. Occasionally, there are intracytoplasmic inclusions suggestive of early vascular formation. The sheets of epithelioid cells occasionally show primitive lumens or rounded vascular spaces.
Discussion: This morphology is typical of epithelioid hemangioendotheliomas. The diagnosis should be confirmed with immunohistochemical markers for vascular differentiation.
The lesion is not a malignant fibrous histiocytoma. There is minimal atypia in the lesion and there is evidence of a spindle cell differentiation.
There is not sufficient pleomorphism to diagnose angiosarcoma. Although there are blood vessels being formed in the neoplasm, they are not simple vascular structures as in present in hemangiomas.
Incorrect
Answer: Epithelioid hemangioendothelioma
Histology: The lesion is a vascular neoplasm in which the principle cell is a rounded epithelioid cell. Occasionally, there are intracytoplasmic inclusions suggestive of early vascular formation. The sheets of epithelioid cells occasionally show primitive lumens or rounded vascular spaces.
Discussion: This morphology is typical of epithelioid hemangioendotheliomas. The diagnosis should be confirmed with immunohistochemical markers for vascular differentiation.
The lesion is not a malignant fibrous histiocytoma. There is minimal atypia in the lesion and there is evidence of a spindle cell differentiation.
There is not sufficient pleomorphism to diagnose angiosarcoma. Although there are blood vessels being formed in the neoplasm, they are not simple vascular structures as in present in hemangiomas.
