PMC3551528_01
Plain radiograph before initiation of radiotherapy shows an irregular and poorly defined destructive lytic lesion with no periosteal reaction in distal humerus associated with pathologic fracture (white arrows) and abnormal adjacent soft tissue density (star).
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F1
In plain radiograph [Figure 1] a destructive lytic lesion with pathologic fracture was found in the distal humerus.
(a) Sagittal and (b) Axial fat suppressed T2-weighted images demonstrate soft tissue mass (white arrows) surrounding the left humerus with destruction of bone cortex and replacement of the involved bone marrow with non-homogenous intermediate signal intensity compared to adjacent bone marrow. Also noted are joint effusion (dashed arrows) accompanied by subcutaneous edema (open arrows).
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F2
In the MRI exam [Figure 2] a soft tissue mass with T1 hypo-signal and T2 intermediate-signal intensities was seen surrounding the distal part of the left humerus associated with destruction of bone cortex.
Tc99 MDP isotopic bone scan demonstrates isolated increased tracer concentration at the distal of left humerus (arrows) which is also persistent in delayed images (right lower corner). Scintigraphic evidence of skeletal metastasis was not found elsewhere.
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F3
Isotopic bone scan [Figure 3] showed isolated increased tracer concentration at the distal part of the left humerus whereas no evidence of skeletal metastasis was found elsewhere.
Section shows a neoplasm composed of pleomorphic, large nonkeratinizing and high nucleus to cytoplasm ratio cells with marked nucleoli arranged in sheet formations which infiltrate soft tissue and bony trabeculi (arrows). Also noted are some foci of necrosis. These findings are consistent with poorly differentiated metastatic squamous cell carcinoma.
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F4
The biopsy from the bone lesion was taken and pathological examination of resected specimen confirmed metastatic squamous cell carcinoma [Figure 4].