PMC4727093_01
Anteroposterior supine pelvic radiograph revealed a large right proximal femur osteolytic lesion (black arrow).
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The patients initial pelvic radiograph revealed a large right proximal femur osteolytic process with cortical disruption (Fig. 1).
(A) Coronal multiple planar reconstruction of the femur observed in bone window indicated cortical destruction without internal matrix or associated bone reaction (white arrow). (B) Axial computed tomography of the femur observed in soft tissue window revealed the presence of a soft tissue mass (black arrow). (C) Volume rendering technique detected bone destruction (black arrow).
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Computed tomography (CT) confirmed the presence of a large non-matrix producing soft tissue lesion in the right proximal femur, which was accompanied of cortical destruction, but did not exhibit surrounding sclerosis or associated periosteal reaction (Fig. 2).
Microscopic examination of the tumor specimen by hematoxylin and eosin stain identified large tumor cells, round or polygonal in shape, with vacuolated cytoplasms abundant in eosinophilic granular bodies (magnification, x100).
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A small number of normal mitoses were also observed (Fig. 3).
(A) Anteroposterior and (B) lateral radiographs did not reveal any abnormalities in the left femur.
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The subsequent X-ray examination was normal (Fig. 4), but plain CT scan revealed a focus of marrow replacement, surrounded by a soft tissue mass without cortical bone destruction (Fig. 5).
(A) Axial enhanced computed tomography examination of left femur identified an homogeneous and sharply marginated mild enhancement surrounding the right femoral cava (white arrow). (B) Sagittal multiple planar reconstruction demonstrated heterogeneous enhancement in the right femoral canal (white arrow).
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The soft tissue mass displayed homogeneous texture, sharp margins and mild enhancement surrounding the right femoral cava, while the marrow replacement exhibited heterogeneous enhancement upon administration of contrast medium (Fig. 6).
(A) Axial T1-weighted imaging demonstrated the signal intensity of the lesion to be mostly isointense, compared with muscle. (B) Axial and (C) sagittal T2-weighted fat-suppression imaging indicated that the signal intensity of the lesion was high (white arrows).
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T1-weighted imaging and bright signal intensity on T2-weighted imaging. The surrounding soft tissue mass displayed the same signal intensity (Fig. 7).
Microscopic examination of the tumor specimen by hematoxylin and eosin stain revealed that the tumor cells aligned diffusely with remarkable heteromorphism (magnification, x200).
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Following limb salvage treatment, microscopic examination of the specimen revealed that the tumor cells aligned diffusely with remarkable heteromorphism (Fig 8), and the adjacent striated muscles were invaded.