Introduction:

In an attempt to reduce stress shielding in the proximal femur multiple new shorter stem design have become available. We investigated the load to fracture of a new polished tapered cemented short stem in comparison to the conventional polished tapered Exeter stem.

Introduction: Haemorrhagic Epithelioid and Spindle Cell Haemangioma (HESCH) is a new entity that was first described by Rosenberg in 1999. We report the first instance of this tumour occurring in pelvis along with literature review.

Case Report: A 65 year-old man presented with complains of pain in left hip radiating to leg of 5 months duration. X-ray & MRI scan (Fig 1, 2, 3) of his pelvis showed lytic destructive lesion in the left inferior pubic rami. Trucut biopsy showed it as a HESCH with no evidence of malignancy (Fig. 4). He successfully underwent pre op. embolization and excision of the tumour including the ischium. His symptoms started to subside within 4 weeks of surgery and he is remaining pain free at one year follow up.

Discussion: Although endovascular tumours are relatively common in soft tissues, for them to be present in the bone is very rare. This is the first reported case of HESCH occurring in the pelvis, as previous cases tend to occur in the small bones of the hands and feet and were thought to be confined to the distal extremities. The age of this patient is also a point of interest, as he is over 2 decades older than the oldest, previously reported case. Histologicaly, a mixture of both epithelioid and spindle cells are seen which grow in a lobular pattern. As the tumour grows, it can lead to destruction of bone. It is important to note that this is a benign tumour with good prognosis.

Conclusion: This case report highlights the good prognosis associated with this form of benign tumour and that embolisation and curettage are the most effective treatment methods.