This 5 years old boy had backache and pain.

The MRI showed T1 bright marrow change from D11 to L3. The left L2 pedicle showed a T1 dark area, which was scheduled for a biopsy. The CT scan showed that this was a soft tissue component scalloping the bone, rather than intra-osseous.

The biopsy was performed under sedation with an 18G coaxial biopsy gun. It was very simple and straightforward. The biopsy result however took a few days and was a tough diagnosis to make. The fin al diagnosis wasa Kaposiform hemangioendothelioma (KHE), CD34 and D2 40 positive.
KHE normally presents with corresponding skin changes. This patient didn’t have any. KHE without skin changes is a rare diagnosis.