Pseudomyogenic Hemangioendothelioma Treated with Zoledronic Acid: A Case Report.
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CASE: An 18-year-old man with no significant medical history presented with persistent anterior knee pain. Imaging revealed multifocal marrow-replacing lesions in the distal femur and patella. Open biopsy confirmed the diagnosis of pseudomyogenic hemangioendothelioma. Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography showed intense multifocal hypermetabolism (SUVmax 13.8). Surgery was deferred due to morbidity, so the patient was treated with intravenous zoledronic acid, resulting in clinical improvement and sustained radiographic and metabolic response over 18 months (SUVmax reduced to 2.26). CONCLUSION: This case highlights a durable radiographic and clinical response to zoledronic acid monotherapy in multifocal pseudomyogenic hemangioendothelioma, supporting its role as a function-preserving systemic therapy.