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Case 260

Surgical Pathology Case


CLINICAL INFORMATION
	16-year-old male, left proximal third humeral tumor.
GROSS DESCRIPTION
	Image: There is an extensive permeative moth-eaten appearance of the proximal metadiaphysis of the left humerus with abnormal periosteal reaction with the appearance of a Codman's triangle. There is evidence of involvement of adjacent soft tissue with apparent cortical breakthrough and probable abnormal osteoid bone proliferation. Sclerotic appearance of the humeral head suggestive of abnormal bony remodeling related to neoplastic involvement, which appears to extend through the humeral neck, and across the growth plate. There is an irregular transverse lucency along the inferior margin of the abnormal bone in the proximal humeral shaft consistent with a pathological fracture. There is mild lateral angulation at the fracture site.




	The specimen consists of a resected proximal humerus measuring 17.0 x 6.5 x 5.5 cm. In the center of the specimen, there is a mass encasing the humerus. The mass measures 6.5 cm in greatest dimension. The distal resection margin is grossly 4.0 cm away from the mass. Upon bisecting the humerus, multiple sclerotic and necrotic areas are identified within the mass. Pathologic fracture is also seen within the humerus.


	HE, 2×	HE, 4×

	HE, 10×	HE, 20×

	HE, 20×	HE, 40×

	HE, 40×	HE, 40×

	HE, 40×	HE, 40×

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	Source: Department of Pathology, Creighton University Medical Center, Omaha, NE Gross photo: MC. Microscopic photo: Zenggang Pan Discussion: Zenggang Pan