PMC4700156_01
Histology of hemipelvectomy specimen showed mononuclear cells with interspersed multinucleated cells (hematoxylin and eosin stain, 20x).
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fig1
Histopathologic analysis showed GCT (Figure 1).
Gadolinium enhanced axial T1 CT (December 2005) of the pelvis with fat saturation demonstrates postsurgical change and irregularity of the right inferior pubic ramus, with an adjacent associated enhancing soft tissue mass (arrows).
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fig2
The recurrent tumor showed progressive, interval growth, reaching a measurement of 3.2 x 3.6 cm in December 2005 (Figure 2), 9.2 x 3.4 cm in January 2008, and 11.0 x 8.9 cm in January 2012, at which time there was possible invasion into the right corpus cavernosum.
Axial CT of the pelvis (February 2015) showed extensive cortical irregularity and cystic spaces (arrows) of the right inferior pubic ramus (bone window algorithm).
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fig3
Follow-up CT scan in February 2015 showed enlargement of the pelvic mass to 13.6 x 13.0 cm with extension into the ischioanal fossa and subsequent mass effect on the rectum, prostate, bladder base, and base of penis (Figures 3 and 4).
Axial CT of the pelvis (February 2015) showed severe interval enlargement of the soft tissue mass (arrows) surrounding the right inferior ramus (soft tissue algorithm).
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fig4
Follow-up CT scan in February 2015 showed enlargement of the pelvic mass to 13.6 x 13.0 cm with extension into the ischioanal fossa and subsequent mass effect on the rectum, prostate, bladder base, and base of penis (Figures 3 and 4).
Biopsy of lung nodule revealed a sarcoma comprised of high grade spindle-shaped cells, consistent with metastatic sarcoma (hematoxylin and eosin stain, 20x).
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fig5
CT guided biopsy of a right lower lobe nodule showed a high grade spindle cell sarcoma with nuclear atypia and low mitotic rate (up to 4 mitoses per high power field) (Figure 5).
Biopsy of enlarging pelvic mass showed a sarcoma comprised of high grade round to epithelioid cells (hematoxylin and eosin stain, 40x).
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S-100 protein staining. Subsequent CT guided biopsy of the pelvic mass revealed a high grade sarcoma with discohesive round to epithelioid cells that expressed SATB2 and weak SMA and lacked p63 (Figure 6).
PMC4700156_02
Histology of curettage specimen showed bland spindle cells and intermixed giant cells (hematoxylin and eosin stain, 20x).
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fig7
Histologic evaluation confirmed giant cell tumor of bone (Figure 7).
Frontal left knee radiograph (August 2007) demonstrates postsurgical curettage and packing with radiopaque polymethylmethacrylate (PMMA) of a well-defined, solitary, mixed lytic, and sclerotic lesion with a narrow zone of transition (arrows), located within the distal femoral metaphysis.
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fig8
One month after surgery, a rim of lucency around the cement packing was noted (Figure 8).
Coronal T1 postcontrast CT (November 2013) demonstrated a heterogeneously enhancing soft tissue mass (arrows) within the lateral aspect of the distal femoral condyle, proximal to the hypointense focus of PMMA.
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fig9
There was minimal interval increase in size on MRI through November 2013, during which time the patient experienced some intermittent left knee pain, when an additional 2 x 1 cm mass was identified, along with mild periostitis along the lateral distal femur (Figure 9).
Frontal left knee radiograph (July 2014) demonstrated increased well-defined lytic focus (arrows) surrounding the radiopaque PMMA, suggestive of malignant transformation.
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fig10
Radiographs showed continued increase in size of the lucency, measuring up to 5.0 cm, with periosteal reaction suggestive of impending pathologic fracture (Figure 10).
Distal femoral amputation demonstrated an ill-defined mass (arrows) proximal to the PMMA packing.
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fig11
The pathology specimen consisted of a 15 cm length of distal femur with minimal attached soft tissue and muscle and with an up to 4.0 cm ill-defined heterogeneous mass proximal to the PMMA (Figure 11).
Histologic examination of area shown in Figure 11 showed atypical, hyperchromatic spindle cells and osteoid formation, consistent with osteosarcoma (hematoxylin and eosin stain, 20x).
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fig12
Histologic examination showed that the mass was comprised of pleomorphic osteoblastic cells in a fibrosarcomatous arrangement with bone, osteoid, and focal cartilage formation (Figure 12).