PMC2662323_01
(a) Plain radiogram showing bone destruction of the rib (arrow). (b) Bone scintigram showing increased spots in the bilateral humerus and the left rib (arrow). (c) Plain radiogram of the left humerus showing an osteolytic lesion (arrow). (d) T1 weighted magnetic resonance imaging showing gadolinium enhancement (arrow).
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fig1
Radiological examination revealed a lesion with bone destruction in the left 6th rib (Figure 1(a)). Bone scintigraphy and positron emission tomography (PET) showed increased uptake in the bilateral humeral shaft and left rib (Figure 1(b)). Plain X-ray films demonstrated an osteolytic lesion in the humeral shaft (Figure 1(c)).  The cortex was thinned. T1 weighted images and iso to high signal intensities on T2 weighted images. The mass was enhanced after gadolinium injection (Figure 1(d)).
the specimen of the abdominal tumor excised in 1995 showing abundant collagen proliferation (a) and alveolar pattern (b).
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fig2
Retrospective histological examination of the specimen removed in 1995 revealed that the lesion was composed of many spindle cells admixed with abundant collagen matrix (Figure 2(a)). Epithelioid cells arranged in an alveolar pattern (Figure 2(b)).
The specimen of the abdominal tumor excised in 2000 showing epithelioid cells arranged in an alveolar pattern, too.
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fig3
In this specimen, epithelioid cells were more dominant than spindle cells, and the epithelioid cells were arranged in alveolar pattern (Figure 3).  These cells showed nuclear polymorphism, and increased frequency of mitosis 15 cells per 10 high-power fields (HPF).
The specimen of the rib excised in 2007 showing cellular atypia and prominent nuclear pleomorphism.
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fig4
In contrast to the primary lesion, this lesion was characterized by much higher cellularity, high nuclear/cell rate, and more prominent nuclear polymorphism (Figure 4).
Ki-67 staining of the specimen resected in 1995. There are few Ki-67 positive cells. Ki-67 labeling index was 7 to 8%.
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fig5
Ki-67 labeling indices were 7~8%, 20%, and 60% in the tumor excised in 1995, in 2000, and in 2007, respectively, (Figures 5, 6, and 7).
The specimen resected in 2000. There were more Ki-67 positive cells than Figure 5. Ki-67 labeling index was 20%.
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fig6
Ki-67 labeling indices were 7~8%, 20%, and 60% in the tumor excised in 1995, in 2000, and in 2007, respectively, (Figures 5, 6, and 7).
The specimen resected in 2007. More cells were stained by Ki-67. Ki-67 labeling index was 60%.
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fig7
Ki-67 labeling indices were 7~8%, 20%, and 60% in the tumor excised in 1995, in 2000, and in 2007, respectively, (Figures 5, 6, and 7).