PMC5576409_01
This contrast chest CT scan shows multiple bilateral masses involving mainly the upper ribs, extending into the thorax and causing mediastinal shift to the left. The largest mass measuring 5,7 cm x 4,1 cm is located on the right side. The masses consist of large multiloculated soft tissue lesions with calcifications. The appearance is mostly suggestive of a chest wall bone tumor with likely soft tissue metastasis.
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Subsequently, a contrast CT scan of the chest was done and revealed multiple bilateral masses arising from the anterior chest wall, bilaterally (Figure 1).
Microscopic findings: (a + b) islands of hypercellular cartilage interspersed within mesenchymal-like stroma of spindle cells. (c) Magnified image of the mesenchymal stroma showing mild atypia (arrow head) and mitosis (arrow). (d + e) Magnified image showing focal endochondral ossification (arrow head) and bone trabeculae (arrow). (f) Area of aneurysmal bone cyst formed of hemorrhagic dilated cystic spaces lined by osteoclasts, giant cells, and collagenous tissue.
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Microscopic examination revealed solid areas composed of islands of multilobulated hypercellular hyaline cartilage interspersed within a mesenchymal-like stroma of bland looking spindle cells (Figures 2(a) and 2(b)). Occasional mitotic activity and mild cellular atypia were identified (Figure 2(c)). Around the chondroid tissue, focal endochondral ossification and trabeculae of bone formation mimicking osteoid formation were noted (Figures 2(d) and 2(e)). In addition, there were areas of aneurysmal bone cyst changes formed of hemorrhagic dilated cystic spaces (Figure 2(f)) and the possibility of osteosarcoma was raised on the frozen section.
PMC5576409_02