PMC5832072_01
Preoperative photograph showing the deformity of the right scapula. The right scapula showed winging with the arm at the side. An upper interval between the spine and medial scapular border was widened, but the lower one was not.
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An upper interval between the spine and the medial scapular border was widened by 70%, but the lower one was not (Figure 1).
Preoperative computed tomography (CT) findings. (a) CT showed the mushroom-shaped osseous tumor composed of a cortex continuous with the scapular cortex, with a broad flat distal end that almost contacted the third rib. (b) Three-dimensional CT revealed the close relationship between the base of the osseous tumor and the superomedial scapular angle.
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Computed tomography showed a mushroom-shaped osseous tumor composed of a cortex continuous with the scapular cortex, with a broad flat distal end that almost contacted with the third rib, as well as a soft tissue tumor between the serratus anterior and the ribcage (Figures 2 and 2).
Preoperative T2-weighted magnetic resonance imaging. (a) Axial view demonstrated the cystic lesion containing a large amount of fluid that surrounded the osseous tumor. (b) Coronal view revealed that the cystic lesion spread over the upper two-thirds of the scapula.
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MRI taken at the previous hospital revealed a cystic lesion containing a large amount of fluid that surrounded the osseous tumor and spread over the upper two-thirds of the scapula (Figures 3 and 3).
Intraoperative photograph showing the exposure of the rib. After resection of the osseous lesion, a large cystic space appeared, covered by a white thick membrane; at the bottom of this space, a 1 x 3 cm section of rib surface covered by edematous synovium was exposed in a defect of the thick membrane.
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After resection of the osseous lesion, a large cystic space appeared, covered by a white thick membrane considered to be inflamed synovial tissue; at the bottom of this space a 1 x 3 cm section of the rib surface was exposed in the defect of the thick membrane (Figure 4).
Macroscopic findings of the distal end of the osseous tumor. The distal surface was rather irregular. The typical thick perichondrium and cartilage cap were not found, although it was covered by spotty fibrocartilage-like tissue.
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Macroscopically, the typical thick perichondrium and cartilage cap were not found, although the flat distal end of the lesion was covered by spotty fibrocartilage-like tissue (Figure 5).
T2-weighted magnetic resonance images taken at the final follow-up 12 years postoperatively. There was no abnormality of the soft tissue or bony structures, although some asymmetry existed.
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MRI showed no abnormality of the soft tissue or bony structures (Figure 6).