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Intraosseous Venous Malformation of the Rib With EWSR1-NFATC1 Fusion Mimicking Malignancy: A Pediatric Case Report

Bridgette McCarty¹, Heather Gochnauer², Xochitl Longstaff²

¹University of California.

Journal of Pediatric Hematology/Oncology

|April 10, 2026

Abstract

Background:

Intraosseous venous malformations are rare, benign vascular bone lesions that may mimic malignant sarcomas on imaging.

Observations:

A 14-year-old male presented with fever and cough. Imaging revealed an incidental ossified rib mass with aggressive features. CT-guided biopsy was nondiagnostic, whereas open biopsy demonstrated a vascular lesion positive for CD31, FLI-1, and ERG. Molecular testing identified an EWSR1-NFATC1 fusion. Gross total resection was achieved, followed by prolonged disease-free survival, and the patient resumed full athletic activity 7 months after surgery.

Conclusions:

This case highlights the value of open biopsy and molecular testing to prevent misdiagnosis and overtreatment of intraosseous venous malformations.

Keywords:

EWSR1-NFATC1 fusion intraosseous venous malformation vascular malformation

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