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

     
 

Click here for diagnosis and case discussion.

 

Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Gross photo: MC. Microscopic photo: Zenggang Pan

Discussion: Zenggang Pan