PMC5055937_01
Case 1 histologic features of the esophageal mass and soft tissue mass. (a) Biopsy of the distal esophageal mass demonstrated infiltrating moderately differentiated neoplastic glands consistent with primary esophageal adenocarcinoma in a background of goblet cell (intestinal) metaplasia (H&E, 40x). (b) MRI of the deltoid muscle soft tissue mass highlighted bone and calcifications within the lesion that is distinctly separate from the humerus (red arrow). (c) Resection of the soft tissue mass at low power magnification showed a well-circumscribed mass of neoplastic glands closely associated with osteoblastic activity within skeletal muscle and fibrosis (H&E, 20x). (d) Resection of soft tissue mass at higher magnification highlighted moderately differentiated neoplastic glands with osteoblastic activity, but lacking bone marrow elements (H&E, 100x).
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The distal esophageal biopsy showed invasive moderately differentiated esophageal adenocarcinoma in the setting of Barrett esophagus (Figure 1(a)). Magnetic Resonance Imaging revealed a 4.7 cm heterogeneous soft tissue mass within the right deltoid muscle lateral to and separate from the humeral shaft (Figure 1(b)). Histologic examination of this soft tissue mass demonstrated neoplastic glandular cells intimately associated with osteoblastic bone formation with no bone marrow elements (Figures 1(c) and 1(d)).
Case 1 immunohistochemical features of the soft tissue mass confirming metastatic focus of esophageal adenocarcinoma. The neoplastic glandular cells were diffusely and strongly positive for CK7 ((a) 200x), CK20 ((b) 200x), CDX-2 ((c) 200x), and Villin ((d) 200x).
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Immunohistochemical studies demonstrated that these neoplastic glandular cells were diffusely positive for CK7, CK20, CDX-2, and Villin (Figures 2(a)-2(d)) (Ventana Medical Systems, Tucson, AZ).
PMC5055937_02
Case 2 histologic features of the sigmoid colon mass, lymph node, and liver masses. (a) CT scan of the abdomen demonstrated liver metastases with marked calcifications within the lesion (red arrow). (b) Left hemicolectomy of the sigmoid colon mass demonstrated moderately differentiated infiltrating neoplastic glands within ulcerated colonic mucosa consistent with primary colonic adenocarcinoma with associated calcifications (H&E, 40x). (c) Resection of lymph node showed foci of metastatic neoplastic glandular cells of colonic primary with associated osteoblastic activity demonstrated by bone formation and calcifications (H&E, 100x). (d) Resections of the liver masses highlighted metastatic neoplastic glands of colonic primary with associated osteoblastic activity demonstrated by calcifications (H&E, 40x).
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The liver masses showed significant calcifications on the imaging (Figure 3(a)). The primary colonic site (Figure 3(b)), metastatic lymph nodes (Figure 3(c)), and liver (Figure 3(d)) metastases demonstrated moderately differentiated neoplastic glandular cells with associated osteoblastic activity, ossification, calcification, and fibrosis.