This 54 years old man with backache and radiculopathy came for an MRI – his x-rays were reported normal, but as you can see on the simulated X-rays from the CT scan data (using the Mean function), there is an expansile lesion involving L1 and L2. The MRI showed a T2 dark lesion and our first diagnosis was a giant cell tumor, though the lesion did involve two contiguous vertebrae and had an unusual scalloped appearance. A vascular tumor may present in this manner, but that’s a difficult diagnosis to make. Given the age (above 45 years), metastatic disease was also a differential.

The biopsy was simple and straightforward with an 18G coaxial biopsy gun.

The final diagnosis was hemangioendothelioma. I don’t think a pre-biopsy diagnosis of this tumor can be made.