PMC7330425_01
(A) Initial AP and axillary radiographs of the right shoulder. The arrows demonstrate a lytic area involving the lateral aspect of the proximal humerus with a periosteal reaction. (B) Initial coronal T1- and T1-contrast enhanced MRI's of the right shoulder demonstrating a tumor involving the proximal humerus with cortical breakthrough and an associated soft tissue mass.
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X-rays of the shoulder were performed (Fig. 1A) and revealed a lytic lesion with a periosteal reaction over the lateral proximal humerus. An MRI of his humerus revealed an aggressive lesion of the lateral proximal humerus (Fig. 1B) with cortical destruction and an associated soft tissue mass.
(A) Intraoperative photograph of the proximal humerus after fixation of the allograft to the host bone. AlloDerm was placed under the plate proximally to provide a surface for repair of the rotator cuff. The articular surface was able to be preserved. (B) Intraoperative photograph of the proximal humerus after repair of the rotator cuff to the AlloDerm. Sutures were also placed through the plate for added fixation.
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AlloDerm (Acelity/San Antonio) was attached to the allograft to enhance fixation of the rotator cuff repair to the allograft. A long proximal humerus plate and screws were used to secure and compress the allograft to the host bone (Fig. 2A). This repair was secured using FiberWire suture (Arthrex/Naples) (Fig. 2B).
Postoperative AP and lateral radiographs of the proximal humerus. The hemicortical allograft is demonstrated proximally with spanning plate fixation. The osteotomy site is still identified.
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Postoperative radiographs are shown in Fig. 3.
Histopathology slide of the operative specimen. A low-grade chondrosarcoma in the upper right is juxtaposed with a high-grade spindle cell sarcoma in the lower left consistent with a dedifferentiated chondrosarcoma.
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Histology demonstrated a low-grade chondrosarcoma juxtaposed with a high-grade spindle cell sarcoma confirming the diagnosis of a dedifferentiated chondrosarcoma (Fig. 4).
Radiographs at final follow-up. AP and lateral radiographs of the proximal humerus demonstrate incorporation of the allograft. The osteotomy site is no longer visualized and there is remodeling of the bone. The articular surface of the humerus is preserved.
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The allograft has radiographic evidence of incorporation without evidence of failure (Fig. 5).