PMC4848434_01
Hip view shows multiple discrete myelomatous lesions in the pelvis and a lucent lesion in the left femoral neck.
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Plain radiographs (Fig. 1) and MRI imaging of the left hip showed lytic lesions in the left femoral neck. A bone survey shortly after transfer showed normal bone mineral content, multiple discrete lytic lesions in the skull, ribs, pelvis, and shoulder girdle and a lytic lesion in the adjacent left supra-acetabular ilium and femoral neck (Fig. 1).
FDG PET/CT scan. (A) Extensive nodular increased activity most evident in long bones such as both humeri and femurs. (B) Conspicuous foci with intense activity are seen in the medial condyle of the right femur (SUV 3.3) and left acetabular roof and femoral neck where a 3 cm lytic lesion is seen with cortical destruction (SUV 15.8).
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A bone scan demonstrated increased uptake in the left hip felt to be a degenerative left acetabulum (Fig. 2). Large lytic lesions were also noted within several regions including the left femoral neck and left acetabular roof which corresponded to the lesions seen on the bone survey (Fig. 2).
Histological examination of the lytic femoral lesion. (A) The lesion is infiltrative and bone destructive (hematoxylin&eosin, x100). (B) A higher power view of the infiltrative tumor cells and admixed megakaryocytes (hematoxylin&eosin, x500). Inset: a tumor cell on touch imprint. (C) The tumor cells are uniformly CD34 positive. (D) Many tumor cells which are positive for Factor VIII-related antigen.
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A repeat marrow biopsy and curettage of the left femoral neck region were performed (Fig. 3). The left femoral neck showed a malignant tumor infiltrate composed of large mononucleated to anaplastic cells with moderate cytoplasm and some multinucleated forms (Fig. 3).
PMC4848434_02