PMC9091404_01
Bone scintigraphy showing increased uptake in the skull, proximal shaft of the right humerus and right humeral head, distal shaft of the left humerus, intertrochanteric region the left femur and both iliac crests.
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F1
99m Technetium 99m -methyl disphosphonate Tc-MDP Bone Scintigraphy showed discrete hot spots in the skull, mainly in the occipital and parietal region, proximal shaft of the right humerus and right humeral head, distal shaft of the left humerus, intertrochanteric region of the left femur and both iliac crests (Fig. 1).
Roentograms showing (a) multiple lytic lesions involving the skull vault. (b) Expansile mixed lytic sclerotic lesion involving the proximal shaft and humeral head of the right humerus. (c) Large expansile predominantly osteolytic mixed with sclerotic lesions involving the left humeral head. (d) Expansile mass with predominantly lytic sclerotic areas involving the left acetabulum, and both femoral heads.
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F2
Roentograms showed large mixed expansile predominantly osteolytic with very minimal sclerotic lesions involving the skull, right humerus and left acetabulum, pubic rami, ischium, and both femoral heads (Fig. 2a-2d).
Microphotography of the biopsy from humeral lesion. (a) H&E staining of the biopsy revealing lipid laden histiocytes characteristic of ECD. (b) Immunohistochemistry showing histiocytes stain positive for CD68. (c) histiocytes stain positive for vimentin. (d) stain negative for S-100.
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F3
On immunohistochemistry (IHC), the histiocytes were positive for CD 68, vimentin, and negative for S-100 and CD1a which was characteristic of ECD (Fig. 3a-3d).