PMC7322230_01
(a,b) Coronal and Saggital sections from CT Skeletal survey for paraproteinaemia. Single 3.2 x 1.5 cm medium low attenuation lesion with a thin sclerotic margin in the midshaft of the right femur causing mild scalloping of the adjacent inner aspect of the medial cortex.
gr1.jpg
PMC7322230_01_gr1.jpg
fig0005
However, CT skeletal survey was ordered as part of the work-up for her thigh pain and showed the lesion in the midshaft of the right femur (Fig. 1). CT demonstrated evidence of a lytic lesion with surrounding sclerosis eroding the cortex of the femoral diaphysis (Fig. 1).
MRI with standard multi-planar technique. (a, b) Coronal and sagittal T2 weighted MRI images of a 1.4 x 2.0 x 3.3 cm showed a hyperintense, well marginated, eccentrically located and marginally expansile lesion involving the mid right femoral shaft. (c) Coronal T1-weighted image showed a well circumscribed cystic lesion of the right femoral shaft with a narrow zone of transition. It was fluid filled and has a relatively homogenous consistency with no cortical expansion. No other focal lesion seen.
gr2.jpg
PMC7322230_01_gr2.jpg
fig0010
Subsequent magnetic resonance imaging detailed a well marginated, low T1 and high T2 signal, eccentrically located and marginally expansile lesion with a homogeneous consistency (Fig. 2).
(a,b) Femur XR post-operatively. The Intramedullary nail in situ in satisfactory position with evidence of excision biopsy site and cortical erosion.
gr3.jpg
PMC7322230_01_gr3.jpg
fig0015
Her operation was successfully performed under consultant supervision and she was discharged day 4 post-operatively after receiving care from the inpatient physiotherapy department (Fig. 3).
(a) Low power image showed a fragmented spindle cell lesion and accellular necrotic bone. (b) High power image showed biphasic appearance with hypercellular Antoni A areas and myxoid hypocellular Antoni B areas. There was evidence of nuclear pallisading around fibrillary processes (verocay bodies) and variable cellular spindle cell proliferation consistent with schwannoma. No atypical infiltrate or evidence of malignancy was seen. (c) Cytoplasmic and nuclear immunohistochemical staining demontrated that the neoplastic cells are positive for S100.
gr4.jpg
PMC7322230_01_gr4.jpg
fig0020
Immunohistochemical staining detected that the lesional cells were positive for S100 and negative for SMA and Desmin (Fig. 4).