PMC4186744_01
Humeral tumor. a: Radiograph of the humerus reveals a lytic proximal lesion with cortical thinning and intralesional calcifications. b: CT scan of the shoulder showing intralesional popcorn-like calcifications. c: MRI T1 images lesion occupying almost the entire humeral epiphysis, with a preserved cortex and no soft-tissue involvement. d: Hematoxylin and eosin staining of clear-cell chondrosarcoma in the humerus consisting of plump cells with well-defined cytoplasmic borders, clear-to-pale eosinophilic cytoplasm and round nuclei. Mitotic figures are scanty and amounts of woven bone are present (x100 magnification). 1e: Joint allograft, without signs of recurrence.
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F1
Radiographs revealed a lytic lesion in the proximal epiphyseal humerus, with calcifications, and cortical thinning and expansion of the bone (Figure 1a). Computed tomography (CT) scan of the shoulder revealed a 5-cm-long intracompartimental lesion with cortical thinning and popcorn-like calcifications (Figure 1b). T1- and hyperintense on T2-weighted images lesion occupying almost the entire humeral epiphysis, with a preserved cortex and no soft-tissue involvement (Figure 1c).Bone scintigraphy showed increased uptake in two lesions: in the proximal humerus- already known - and in the contralateral distal femur - an asymptomatic lesion (Figure 2).Radiographs of the knee confirmed a lytic lesion in the medial condyle with a sclerotic margin. The lesion was clinically asymptomatic and the patient had full range of motion in the joint (Figure 3a). CT scan of the thorax was normal and alkaline phosphatase within normal limits.Needle biopsies were performed and the diagnosis of CCC was confirmed in both sites (Figures 1d and 3d).Wide tumor resection of the proximal humerus was performed followed by allograft reconstruction of the joint with osteosynthesis. The femoral condyle lesion was treated with curettage, phenolization, and cementation, in the same time (Figures 1e and 3e).
Whole-body bone scan with increased uptake in two foci.
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F2
T1- and hyperintense on T2-weighted images lesion occupying almost the entire humeral epiphysis, with a preserved cortex and no soft-tissue involvement (Figure 1c).Bone scintigraphy showed increased uptake in two lesions: in the proximal humerus- already known - and in the contralateral distal femur - an asymptomatic lesion (Figure 2).Radiographs of the knee confirmed a lytic lesion in the medial condyle with a sclerotic margin. The lesion was clinically asymptomatic and the patient had full range of motion in the joint (Figure 3a).
Imaging of the knee. a: radiograph: well limited lytic condylar image with a sclerotic rima. b: Axial CT scan of the knee showing a lytic lesion with calcifications and without cortical disruption. c: MRI T2-weighted image shows a homogeneously hypointense and well delineated lesion. There is no peri lesional edema. d: Femur clear cell chondrosarcoma on hematoxylin and eosin staining shows morphologically an indistinct lobularity and fine fibrovascular septa separate sheets of clear cells associated to delicate trabeculae of osteoid and rare multinucleated giant cells (x100 of magnification). e: Radiograph of the knee after curettage, phenolization, and cementation.
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F3
T1- and hyperintense on T2-weighted images lesion occupying almost the entire humeral epiphysis, with a preserved cortex and no soft-tissue involvement (Figure 1c).Bone scintigraphy showed increased uptake in two lesions: in the proximal humerus- already known - and in the contralateral distal femur - an asymptomatic lesion (Figure 2).Radiographs of the knee confirmed a lytic lesion in the medial condyle with a sclerotic margin. The lesion was clinically asymptomatic and the patient had full range of motion in the joint (Figure 3a). CT scan of the knee confirmed a well-circumscribed lytic lesion with a sclerotic rim, cortical thinning without disruption of the bone (Figure 3b) . MRI of the knee displayed a round homogeneous well limited hypodense on T1-weighted sequence lesion (Figure 3c). CT scan of the thorax was normal and alkaline phosphatase within normal limits.Needle biopsies were performed and the diagnosis of CCC was confirmed in both sites (Figures 1d and 3d).Wide tumor resection of the proximal humerus was performed followed by allograft reconstruction of the joint with osteosynthesis. The femoral condyle lesion was treated with curettage, phenolization, and cementation, in the same time (Figures 1e and 3e).