PMC4729015_01
(a) Planar X-ray of left tibia, (b) Magnetic resonance imaging transaxial cut of proximal left tibia, (c) Magnetic resonance imaging left tibia
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F1
(a) Whole body blood pool and whole body delayed images, (b) Whole body bone scan versus whole body methoxy-isobutyl-isonitrile scan
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F2
The patient was referred to nuclear medicine to further evaluate the extent of the primary lesion and to determine other sites of possible metastases. 99mTc-methylene diphosphonate (99mTc-MDP) whole body blood pool and 3 h delayed whole body [Figure 2a] bone scan were done. A 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) whole body scan [Figure 2b] was performed 2 days after the bone scan to determine the extent of the metabolically active component of the tumor.
Largest tissue fragment taken
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F3
Medicine Gamma Finder) [Figure 3]. Multiple fragments of tissue were taken for histology; the largest was 17 x 15 x 5 mm.
Histology revealed biphasic tumor
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F4
The epithelial component displayed three different patterns, basaloid [Figure 4a], fascicular [Figure 4b], and tubular [Figure 4c]. Immunohistochemistry for pancytokeratin [MNF 116] [Figure 4d] revealed a strong expression in the epithelial component and negative in stromal component.
Whole body methoxy-isobutyl-isonitrile scan postsurgery
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F5
This scan showed no abnormal uptake [Figure 5].