Presentation
Large humeral mass identified just prior to childbirth. Developed over several months.
Patient Data
Lucent destructive lesion in the right humeral head and neck with cortical destruction.
Moth eaten appearance to the proximal humeral diaphysis.
Destructive bone based lesion centered on the right humeral head, extending into the metadiaphysis.
Acromion intact.
Contrast not administered as patient breast feeding.
The humeral head and neck is replaced with a soft tissue mass with high T2, low T1 signal material, with several high T1 foci in keeping with intra-tumoral hemorrhage.
Extension into the proximal diaphysis.
No synchronus lesion.
CORE BIOPSY - HISTOPATHOLOGY REPORT
Cellular malignant tumor composed of spindle and round cells in a vague storiform pattern. Bizarre giant cells are noted. No osteoid.
The tumor cells positively for vimentin, CD99, smooth muscle actin and myoglobin.
Conclusion: Undifferentiated pleomorphic sarcoma
Case Discussion
Malignant fibrous histiocytoma (MFH) has now been re-termed with a more meanful pathological identity as a pleomorphic undifferentiated sarcoma.
It is a soft tissue based tumor, which can occur anywhere in the body. Less than 5% are bone derived as in this case.
MFHs occur in adults (range 32-80; mean 59 years) with a slight male predilection with a M:F ratio of 1.2:1). Presentation is usually with an painless, enlarging palpable mass - as in this case.
Core biopsy confirmed the diagnosis. The prognosis, as is usual with all sarcomas, is poor.
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