PMC3479942_01
Conventional radiograph of the left lower ribs shows a well-circumscribed, ovoid lytic lesion (arrow) near the anterior aspect of the left tenth rib, causing thinning of the cortex and expansion of the bone.
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A well-circumscribed, ovoid lytic lesion was detected at the middle part of the left tenth rib, causing thinning of the cortex and expansion of the bone (Figure 1).
CT shows a soft tissue density lesion causing severe thinning of the bone cortex. The apparent area of cortical disruption (arrow) was not confirmed histologically and can be attributed to partial volume averaging.
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Computed Tomography (CT) confirmed the presence of the lesion, which showed soft tissue density (Figure 2).
MR imaging of the tumor (arrows). (a) T1W, sagittal section shows an ovoid lesion with intermediate signal intensity, slightly higher than that of muscle. (b) T2W, axial section shows that the lesion has a high signal center and an intermediate signal periphery. After administration of paramagnetic contrast agent, there is both central and peripheral-periosteal enhancement. ((c) sagittal T1W + CM, (d) axial T1W FatSat + CM). The perilesional soft tissues show no signs of invasion. The findings are atypical.
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After administration of paramagnetic contrast agent, both central and peripheral-periosteal enhancement was noted (Figure 3).
Histologic section of the tumor (Hematoxylin-Eosin x400). Giant, multinucleated cells, lacking atypia or mitotic activity are present. The arrow points to one of these cells. Giant cells are disposed isolated or in small nests in abundant stroma. This is composed of spindle-shaped cells (some with storiform disposition, also lacking atypia or mitotic activity) and extravasated erythrocytes.
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Pathologic examination confirmed the complete resection of the lesion, which measured 2 x 1.3 cm and a diagnosis of giant cell tumor of bone was obtained (Figure 4).
CT (3 years postoperatively), 3D reconstruction of the thoracic skeleton, showing the surgical defect at the middle part of the left 10th rib (arrow).
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Followup was performed with CT (Figure 5), MRI, and laboratory tests.