PMC546198_01
A Plain radiograph of the right shoulder, showing an irregular, mixed lytic and sclerotic lesion in the glenoid (arrow), that was not appreciated by the reporting radiologist. B Arthrogram performed prior to hydrodilatation. C Coronal TSE post-contrast MR image, showing a diffusely enhansive scapular lesion extending into the inferior aspect of the gleno-humeral joint. D Axial TSE post-contrast MR image showing diffuse enhancement of the tumour extending on either side of the scapular blade with bony destruction. E Bone scan showing increased uptake in the area of the lesion on the delayed static image. F Thallium functional scanning showing retained thallium activity in the glenoid region at 4 hrs. Subsequent biopsy was consistent with Ewing's sarcoma.
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F1
MRI was then performed, which demonstrated a large permeative tumour arising from the scapula (Figure 1).
PMC546198_02
A Plain radiograph of the left shoulder showing a lytic lesion affecting the proximal humerus, with cortical irregularity medially (arrow), that was not initially recognized. B At the time of arthrographic distension, the lesion (arrow) was more apparent, but remained unnoticed. C Sagittal TSE post-contrast MR image showing an enhancing lesion within the proximal humerus extending outside the bone. D Axial TSE post-contrast MR image showing the tumour destroying the humeral head and extending into the gleno-humeral articulation. E Bone scan showing increased uptake in the area of the lesion on the delayed static image. F Thallium functional scanning showing retained thallium activity in the proximal humerus at 4 hrs. Histological sections from the biopsy and surgical resection specimen were consistent with a malignant fibrous histiocytoma.
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F2
On retrospective review of plain x-rays of the shoulder, a destructive lesion at the metaphysis with a cortical breach medially in the region of the surgical neck of the humerus was realized (Figure 2).
PMC546198_03
A Initial plain radiographs of the shoulder were unremarkable. B Repeat radiographs after two years of failed treatment, showing an irregular mixed lytic and sclerotic lesion destroying the coracoid process of the scapula (arrow), which was not appreciated. C Arthrogram performed prior to hydrodilatation similarly showing the destructive process, which remained unnoticed. D Axial T1-weighted post-contrast MR image showing a heterogenous contrast-enhancing lesion destroying the glenoid and extending into the gleno-humeral joint. The lesion is lobulated and loculated with central areas of lower signal intensity, suggestive of a chondroid lesion. E Bone scan showing increased uptake in the area of the lesion on the delayed static image. F Thallium functional scanning showing no retention of thallium by the lesion at 4 hrs. Biopsy confirmed low-grade chondrosarcoma.
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F3
Repeat plain radiographs two years after the onset of her symptoms demonstrated a large lesion extending from the glenoid cartilage into the base of the coracoid process (Figure 3).
PMC546198_04
Patient had persistent pain and stiffness following hydrodilatation. A Plain shoulder radiographs were normal. B STIR MR image showing multiple high signal intensity lesions in the supraspinatus muscle. A presumptive diagnosis of metastatic squamous cell carcinoma was made.
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F4
An MRI was performed, which showed lesions in the supraspinatus and trapezius muscles, which were consistent with metastatic deposits (Figure 4).
PMC546198_05
A Initial plain radiographs of the right shoulder appeared normal. B CT scan was performed after a year of progressive shoulder pain and stiffness, showing a destructive lesion involving the glenoid (arrow). C Axial T1-weighted and post-contrast (D) MR images showing destruction of the glenoid with an associated soft tissue mass and involvement of the humeral head. E Bone scan showing increased osteoblastic activity involving the coracoid process and right humeral head and relative photopaenia of the glenoid. F CT-guided percutaneous biopsy was able to obtain a histological diagnosis of malignant fibrous histiocytoma.
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F5
Plain films were performed at the time which appeared normal (Figure 5). CT and MRI scanning confirming destruction of the glenoid with an associated soft tissue mass and involvement of the humeral head (Figure 5). CT-guided percutaneous biopsy was performed and diagnosis of malignant fibrous histiocytoma made.