Epithelioid hemangioendothelioma of the bone A case report with findings of bone scintigraphy
Epithelioid hemangioendothelioma of the bone A case report with findings of bone scintigraphy
复制标题
DOI：
10.1097/md.0000000000015546
复制
发表时间：
2019-05-01
期刊：
影响因子：
1.6
通讯作者：
Lin, Zhiyi
中科院分区：
文献类型：
--
作者：
Xu, Yijin;Chen, Wenxin;Lin, Zhiyi
简介：骨上皮样血管内皮瘤是一种非常罕见的恶性血管肿瘤，其生物学行为介于局部侵袭性上皮样血管瘤和恶性上皮样血管肉瘤之间。我们报告一位EHE患者接受骨显像的病例，试图确定其特征，以强调全身骨显像和单光子发射计算机断层扫描/计算机断层扫描的临床重要性（SPECT/CT）在诊断和治疗EHE中的应用。一名67岁男性，无外伤史，报告双下肢疼痛6个月，在过去20天内恶化。双下肢的前后位和侧位X线片显示双侧胫骨和腓骨有大量溶骨性病变。Tc-99 m-亚甲基二膦酸盐（MDP）骨显像显示骨盆和双侧下肢骨的示踪剂摄取增加。SPECT/CT骨成像显示同一解剖区域内有大量溶骨性病变簇，病变边缘有高示踪剂摄取。诊断：骨EHE。干预措施：确诊后两个月，患者再次住院。非阿片类镇痛药的使用没有提供疼痛缓解。双侧大腿磁共振成像（MRI）显示骨皮质被破坏，伴有大量不规则病变，并累及软组织。第二次骨造影未显示任何新病变。结果：患者自愿出院，2个月后死亡。结论：骨EHE是一种非常罕见的恶性血管肿瘤，影像学表现无特异性。全身骨显像，尤其是SPECT/CT骨显像，可显著减少不明确的诊断，建议在治疗前进行。
Introduction: Epithelioid hemangioendothelioma (EHE) of the bone is a very rare malignant vascular neoplasm, with biologic behavior between that of locally aggressive epithelioid hemangioma and malignant epithelioid angiosarcoma. We report a case of a patient with EHE who underwent bone scintigraphy, try to identify the characteristics of it, to highlight the clinical importance of whole-body bone scintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) in the diagnosis and treatment of EHE.Patient concerns: A 67-year-old man with no history of trauma who reported pain in both lower limbs for 6 months, which had been worsening over the last 20 days. Anteroposterior and lateral radiographs of both lower limbs revealed numerous osteolytic lesions in the tibia and fibula bilaterally. Tc-99m-methylene diphosphonate (MDP) bone scintigraphy demonstrated increased tracer uptake in the pelvic and bilateral lower limb bones. SPECT/CT bone imaging showed numerous osteolytic lesions cluster in the same anatomic region, with high tracer uptake in lesion margins.Diagnosis: EHE of the bone.Interventions: Two months after the diagnosis was confirmed, the patient was rehospitalized. Nonopioid analgesic use had not provided pain relief. Magnetic resonance imaging (MRI) of both thighs showed the bone cortex was destroyed with numerous irregular lesions, and soft-tissuewas involved. A second bone scintigraphy did not show any new lesions. He was administrated with recombination human endostatin injection 15mg ivgtt qd for 14 days, combined with apatinib mesylate tablets 500mg po qd for 18 days.Outcomes: He was discharged voluntarily and died 2 months later.Conclusion: EHE of the bone is a very rare malignant vascular neoplasm with no specific radiographic imaging features. Whole-body bone scintigraphy, especially SPECT/CT bone imaging, significantly reduces ambiguous diagnoses and is recommended before treatment.