PMC3629270_01
Photograph showing the ~6x5-cm superficial mass in the posterolateral aspect of the left proximal thigh.
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Physical examination revealed a ~6x5-cm superficial, firm, non-tender mass in the posterolateral aspect of the left proximal thigh (Fig. 1).
(A) Plain radiograph reveals a soft tissue mass with amorphous calcification and extensive foci of ossification. (B) Three-dimensional computed tomography image shows the presence of the lesion and the normal appearance of the proximal femur. (C) Technetium-99m hydroxymethylenediphosphonate bone scintigraphy reveals heterogenous uptake in the lateral soft tissue of the left proximal thigh.
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Plain radiographs showed a soft tissue mass with amorphous calcification and extensive foci of ossification (Fig. 2A). Computed tomography (CT) images demonstrated and confirmed an incompletely ossified shell in the lesion (Fig. 2B). Technetium-99m hydroxymethylenediphosphonate bone scintigraphy demonstrated heterogenous uptake in the lateral soft tissue of the left proximal thigh (Fig. 2C).
Axial magnetic resonance images of ossifying fibromyxoid tumor in the left proximal thigh. (A) The T1-weighted sequence shows that the mass has low to intermediate signal intensity. (B) The T2-weighted spectral presaturation with inversion recovery sequence shows that the mass has heterogeneous high signal intensity with foci of low signal intensity. (C) The contrast-enhanced T1-weighted sequence shows heterogenous enhancement throughout the mass.
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The mass exhibited low to intermediate signal intensity on T1-weighted sequences (Fig. 3A) and heterogeneous high signal intensity, with foci of low signal intensity, on T2-weighted spectral presaturation with inversion recovery sequences (Fig. 3B). Contrast-enhanced T1-weighted sequences demonstrated heterogenous enhancement throughout the mass (Fig. 3C).
Cut section of the ossifying fibromyxoid tumor displaying a well-circumscribed, gray-white, multinodular appearance.
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A cut section revealed that the tumor was gray-white, solid, multinodular and rubbery to firm in consistency (Fig. 4).
Histopathological and immunohistochemical findings of ossifying fibromyxoid tumor. (A) The tumor is composed of relatively uniform round to oval cells with eosinophilic cytoplasm. (B) A peripheral shell of mature lamellar bone is evident. The tumor cells are immunoreactive for (C) S-100 protein and (D) neuron-specific enolase.
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Histopathologically, the tumor was composed of uniform oval, polygonal or spindle-shaped cells, accompanied by an abundant fibromyxoid stroma (Fig. 5A). Ossification-forming bone shells were found in the periphery of the tumor (Fig. 5B). Immunohistochemically, the tumor cells were positive for vimentin, S-100 protein (Fig. 5C) and neuron-specific enolase (Fig. 5D), and focally for smooth muscle actin and CD56.