PMC6495474_01
Pre operative x-ray of left elbow. There is lytic area in proximal of the ulnar bone.
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We did an elbow x-ray that shows a soft tissue mass on the medial side of the elbow, a radiolucent area within distal of the humeral and proximal of the ulnar bone (Fig. 1).
Pre operative MRI of right forearm. Hyperintense heterogen mass was seen at proximal ulnar bone that involves pronato teres, flexor digitorum superficialis, and fleksor carpi ulnaris muscles. The mass caused irregularity, necrotic area, and destruction of the proximal ulnar bone which suggested a malignant lesion.
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MRI examination suggested a malignant bone tumor in the epi-meta-diaphyseal of left ulnar bone extended into proximal humeroulnar and radioulnar joints without neurovascular involvement (Fig. 2).
Intraoperative procedure. (A) Exposing the tumor followed by wide excision of the proximal ulnar bone. (B) Elbow arthroplasty reconstruction. (C) Defect closure with latissimus dorsi flap.
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We performed a latissimus dorsi flap to enclose the relatively wide excised area (Fig. 3).
Macroscopic of tumor. Tumor size 10.3 x 6.8 x 5.2 cm, red- white colours, with solid palpable, and necrotic in the borders area.
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Resected tumor (Fig. 4) was sent for histology confirmation.
Histology of resected tumor. Osteoclastic giant cells surrounded by oval or spindle mononuclear cells in a fibrovascular stroma and lack of osteoid matrix.
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The histology of resected tumor was evenly distributed osteoclastic giant cells surrounded by oval or spindle mononuclear cells in a fibrovascular stroma (Fig. 5).