PMC4344168_01
Xray right shoulder AP view showing irregular permeative type of lytic lesions involving proximal metadiaphysis region of the right humerus, cortical breaks, interrupted periosteal reaction and a wide zone of transition. No significant soft tissue component is present.
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Cortical breaks and interrupted periosteal reactions were present (Figure 1).
Magnetic resonance imaging showed focal cortical lytic lesion in the head of right humerus and greater tuberocity
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Magnetic resonance imaging showed focal cortical lytic lesion in the head of right humerus and greater tuberocity, glenoid and corocoid process and right clavicle with moderate periosteal reaction (Figure 2).
CT both shoulder axial view (bone window) showing irregular destructive lytic lesions of right upper humerus.
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A computed tomogram showed permeative destruction of both shoulder joints and pelvic bones (Figure 3).
Bone scan showing increased uptake over both humerii, trochanters and shaft of right femur
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A Tc99 bone scan showed hot spots over upper end of both humerii, trochanter of both femur, shaft of right femur (Figure 4).
PAS X1000. Blasts show PAS block positivity
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These blasts were myeloperoixase negative and showed PAS block positivity. (Figure 5 and 6).
Myeloperoxidase x 1000. Blasts are myeloperoxidase negative
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These blasts were myeloperoixase negative and showed PAS block positivity. (Figure 5 and 6).
Flowcytometry dot plot scan showing blast cells with negative uptake for CD13,CD33,CD34,CD68,CD10,CD117,MPO and positive uptake for anti glycophorin A (70%)
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The blasts were positive for glycophorin A (Figure 7).
H&E x 400. Section from bone shows infiltration by blasts.
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The biopsy from the humerus shows spicules of bone with intervening neoplasm showing tumor cells in sheets (Figure 8).
IHC analysis for LCA showing negative uptake by blast cells
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Cells were negative for LCA, MIC2 (Figure 9 and 10).
IHC analysis for mic 2 showing negative uptake by blast cells
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Cells were negative for LCA, MIC2 (Figure 9 and 10).