PMC5661444_01
X-ray and CT images of the patient. (A) Preoperative X-ray of this patient showed that there was lytic destruction within the left proximal humerus, mixed with coarse trabeculation and sclerotic margin; (B) Cross section of the CT image showed cortical destruction without periosteal reaction; (C) CT image showed a lytic lesion with sclerotic margin (arrow); and (D) CT image showed coarse trabeculation within the lesion.. Abbreviation: CT, computed tomography.
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Plain radiographs in our hospital showed a lytic, expansible lesion with a sclerotic margin in the proximal humerus (Figure 1). CT images revealed there was predominantly lytic mixed with coarse trabeculation and densely sclerotic slight cortical destruction in the tumor (Figure 1).
MRI images of this patient. (A) The lesion presented low signal on T1 sequence; (B) the lesion presented a relatively high signal than the adjacent muscle but a weaker signal than liquid on T2-sequencing images; (C) coronal section of the MRI image showed the lesion presented mixed signals on T2 sequence; and (D) a cross-section of the MRI image on T1 sequencing reveals a lesion with a slight enhancement.
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MRI showed that the lesion presented low signals on T1-sequence, and mixed signals on T2-sequence, images with a slight enhancement (Figure 2).
Bone scan showed the lesion had nuclear tracer uptake.
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An increased nuclear uptake at the destruction area was found on bone scan (Figure 3).
Postoperative images of this patient. (A and B) show the tumor specimen. The tumor arose within the medullary cavity of the proximal humerus and there is a sclerotic margin that separates the tumor from the normal medullary structures (red arrow); (C) Postoperative X-ray showed the location of the prosthesis was good, without dislocation.
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The length of the tumor segment was 5.4 cm, and the resection length was 7.5 cm so that there was a 2 cm-tumor-negative margin (Figure 4).
Pathological images of the tumor. (A) Hyperchromatic fibroblast-like cells with mild nuclear atypia and occasional mitotic activity on H&E staining (x200, scale bar 50 mum); focal osteoid production (red arrow) was present within the moderately cellular fibroblastic stroma; (B) shows strong positive staining for SMA on immumohistochemical staining (x200, scale bar 50 mum); (C) shows strong CDK4 positivity of the tumor on immumohistochemical staining (x200, scale bar 50 mum); (D) shows focal weak MDM2 positive on immumohistochemical staining (x200, scale bar 50 mum).
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The final pathological diagnosis was LGCOS with strong CDK4 and SMA positivity and focal mild MDM2 positivity on immumohistochemical staining (Figure 5).