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Pseudomyogenic hemangioendothelioma (PMH) of bone is a very rare tumor and frequently presents at multiple locations. PMH is difficult to diagnose by imaging and histopathologic features. Various and partially discordant imaging findings have been reported in case reports and small case series. We report a case of a 63-year-old man with PMH isolated to the sacrum, presenting with chronic intermittent buttock pain that was incidentally identified on imaging for acute pancreatitis. We believe that learning about PMH of bone will help to include this disease in the differential diagnosis of lytic lesions of the sacrum. Becoming aware of the various and sometimes discordant imaging findings of this rare entity is important and helpful for radiologists, pathologists, and orthopedic surgeons. Keywords: Pseudomyogenic hemangioendothelioma, Vascular bone tumors, Sacrum, Epithelioid sarcoma-like hemangioendothelioma

Pregnancy presents unique obstacles to diagnosis and management of urologic disease. We present a case of a primigravid female with clot retention requiring evacuation in the operating room due to the avulsion of a bladder mass which prolapsed during labor. Tumor pathology demonstrated a low-grade spindle cell lesion positive for progesterone receptor (PR) and high mobility group A2 (HMGA2), suggestive of deep angiomyxoma versus a benign fibroepithelial polyp or inflammatory myofibroblastic tumor.

Objective: Present a case of an atypical parathyroid adenoma with extreme clinical features and discuss the uncertainties in differentiating between benign and malignant masses.Methods: The clinical, laboratory, and imaging findings are presented with a literature review of current methods for distinguishing parathyroid adenoma from carcinoma.Results: A 37-year-old man presented to his primary care physician with worsening bone pain and increasing irritability over the span of 2 years. Laboratory evaluation showed a highly elevated serum calcium (15.7 mg/dL) and parathyroid hormone (1,790 pg/mL). Computed tomography revealed multiple brown tumors throughout his body and a 2.8-cm mass in the tracheoesophageal groove. Fine-needle aspiration of the 2.8-cm mass was suggestive of a neoplastic/hyperplastic process but could not definitively identify thyroid or parathyroid cells. The patient underwent surgery 2 weeks after initial diagnosis. Because intra-operative histopathology was suggestive of parathyroid adenoma, simple parathyroidectomy was performed. The final pathology report, however, demonstrated atypical features that were suggestive but not diagnostic of parathyroid carcinoma. The patient was ultimately given a diagnosis of atypical parathyroid adenoma but continues to be monitored for signs of malignancy.Conclusion: Parathyroid adenoma and carcinoma differ greatly in their disease progression and standard of care. Fine-needle aspiration should be avoided if high clinical suspicion for a parathyroid mass. While histopathology is the mainstay for differentiating between parathyroid adenoma and carcinoma, it may fall short for tumors with ambiguous features. Literature review suggests that immunohistochemistry may be an increasingly valuable tool in differentiating between benign and malignant parathyroid masses.