PMC4936498_01
Magnetic resonance imaging coronal view (panel A) and sagittal view (panel B) showing clearly the lesion with some calcification.
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Routine blood tests were within normal range and review of the computed tomography (CT) and magnetic resonance imaging (MRI) scans which were done outside confirmed the presence of a soft tissue mass which was unlikely to be a lipoma (Fig. 1).
An operative view showing the lesion as it was dissected from the surrounding structure (Panel A). Panel B showing the excised mass which looked well encapsulated with a smooth surface.
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Fine needle aspiration cytology (FNAC) was offered, but refused by the patient and hence surgical resection of what appeared to be an encanpsulated mass (Fig. 2) was carried out.
Micrograph of the resected lesion showing an area of the tumor featuring spindle cells within loose stroma with associated nuclear atypia and scattered mitotic figures (panel A; H&E stain. x200). The microscopic field in panel B shows the presence of bony trabeculae surrounded by large malignant hyperchromatic, multinucleated bizarre cells (H&E stain x200). Panel C shows the tumor acquiring a pleomorphic undifferentiated (malignant fibrous histiocytoma-like) pattern (H&E stain x200). Panel D shows an area with chondrosarcomatous differentiation (H&E stain x200).
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In addition, areas with marked osteosarcomatous and chondrosarcomatous differentiation were identified (Fig. 3A-D).
The metastatic lesion in the right lung as it appeared on CT scan (left panel) and PET scan (right panel) with an avid uptake (SUVmax 6.8).
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However, at 12-month follow-up a body combined 18F-fluorodeoxyglucose-positron-emission tomography and CT (FDG-PET-CT) scan showed a right lung metastatic nodule with avid FDG activity (SUVmax 6.8) (Fig. 4).