PMC4080674_01
Photomicrograph of pathology section showing osteoclastic giant cells and pleomorphic malignant cells amidst osteoid (H and E, x 200)
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F1
A biopsy specimen from the mass, on histopathological examination revealed osteoid deposition by tumor cells, with osteoclastic giant cells and pleomorphic malignant cells within the osteoid, suggestive of osteosarcoma [Figure 1].
(a) Maximum intensity projection image showing tracer uptake in left supraclavicular region (2a-arrow), in the region of mid thorax, mid abdomen, right lung, right kidney, left pelvis (all arrow heads) (b) axial fused PET/CT images show FDG avid mass arising from left trapezius muscle (arrow) (c) oblique coronal CT and fused PET/CT (d) images show origin of the mass from left trapezius, with no involvement of left scapula
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F2
Maximum Intensity Projection (MIP) images [Figure 2a] revealed a large focus of tracer concentration in left supraclavicular region [Figure 2a arrow], with multiple foci of uptake in the right hemithorax, region of the right kidney, left pelvis, mid thorax and abdomen [Figure 2a all arrowheads]. Fused axial PET/CT images showed tracer uptake in a bulky soft-tissue mass arising from the left trapezius muscle, [Figure 2b arrow], which was the site of primary malignancy. There was no involvement of left scapula noted on the CT component of the study, confirmed on coronal oblique CT [Figure 2c arrow] and PET/CT [Figure 2d arrow] images.
Axial fused PET/CT images show FDG avid metastatic lesions in brain (a - arrow), left iliac marrow (b - arrow), D12 vertebral body (c - arrow), left internal oblique muscle (d - arrow) and right renal cortex (e - arrow)
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F3
Furthermore seen was intense FDG uptake in the right lung mass, left iliac bone marrow [Figure 3b arrow], D12 vertebra [Figure 3c arrow], within a soft-tissue deposit in the left internal oblique muscle [Figure 3d arrow], in right renal cortex [Figure 3e arrow] and in medial end of left clavicle. Also noted was tracer uptake in the brain, which correlated to a soft-tissue lesion in right paraventricular region, with specks of calcification within, seen on axial fused PET/CT [Figure 3a arrow].