Sacral hemangioma (huge)
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A large lobulated enhancing mass is centered on the sacrum completely effacing the sacral canal and displacing pelvic content anteriorly. It is bright on T2 and low signal on T1 with prominent enhancement.
The patient went on to have a biopsy.
The sections show a soft tissue proliferation composed of a myxoid spindle cell matrix within which are dispersed vascular structures of varying diameter and thicknesses, typical of a hemangioma. The spindle cell matrix is considered reactive and coexists with fresh hemorrhage and hemosiderin deposition. The lesional tissue is present at the biopsy margins.
Final diagnosis: intraosseus hemangioma.