PMC8415166_01
Plain radiography of pelvis at the first week of local pain showed flake bone destruction in right femoral trochanter.
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Plain radiography of pelvis (Figure 1) showed flake bone destruction in right femoral trochanter.
CT scan of pelvis at the first week of onset demonstrated a permeative pattern of bone destruction in the femerol head and neck which poorly marginated with laminar periosteal reaction. A high bone density lesion was detected under the articular surface of right acetabulum. The breadth of the joint space was normal.
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To evaluate the lesion, computed tomography (CT) scan of the lesion (Figure 2) demonstrated poorly marginated bone destruction in the femerol head and neck.
MRI of pelvis at the first week of onset presented a wide range capsule-patterned bone destruction of right femoral head and trochanter with high signal intensity in T2-weight imaging (T2WI) while lower and mixed signal intensity in T1-weight imaging (T1WI). Cortical breakthrough was detected on the anterior of femoral trochanter, and surrounding soft tissue was swelling while acetabulum and joint space was normal.
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Moreover the magnetic resonance imaging (MRI) of pelvis (Figure 3) presented a wide range capsule-patterned bone destruction of right femoral head and trochanter.
A whole-body tomography positron-emission tomography and computed tomography using 18F-fluorodeoxyglucose (18F-FDG) demonstrated a huge cauliflower-like appearance skeletal lesion with very high fluorodeoxyglucose uptake (SUV max 8.0) in the upper segment of right femur. It was noted that the 18F-FDG avidity was not detected in the lymph nodes or any internal organs.
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The whole-body positron-emission tomography and computed tomography (PET-CT) using 18F-fluorodeoxyglucose (18F-FDG) demonstrated a very high fluorodeoxyglucose uptake (SUV max 8.0) in the upper segment of the right femur (Figure 4) and magnetic resonance imaging (MRI) showed that a large cauliflower-like tumor tissue completely eroded the right articulation coxae (Figure 5).
MRI imaging at the fourth month of onset detected bone destruction and low intensity in T1WI while mixed intensity in T2WI mainly localized at the upper segment of femur. It is surrounded by cauliflower-like soft tissue mass with size of approximate 12.6 cm by 21.5 cm in great dimension. Jacent gluteus, iliopsoas, musculi obturator extemus and muscle group of right thigh acetabulum were eroded.
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The whole-body positron-emission tomography and computed tomography (PET-CT) using 18F-fluorodeoxyglucose (18F-FDG) demonstrated a very high fluorodeoxyglucose uptake (SUV max 8.0) in the upper segment of the right femur (Figure 4) and magnetic resonance imaging (MRI) showed that a large cauliflower-like tumor tissue completely eroded the right articulation coxae (Figure 5).
Hematoxylin and eosin (HE) and immunohistochemical staining shows CD4+, CD5-, CD43+, MIB-1 40%+ LCA+.
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These cells presented prominent atypia (Figure 6).
Pulmonary CT scan showed the multi-transfer lesions of lung at the 11th month of onset.
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While waiting for a bone marrow match, radiological evidence showed multiple metastatic lesions in his lungs at the 15th month of his onset (Figure 7), and the patient died 2 months later.