Presentation
Swelling and pain in left side of the back.
Patient Data
Large expansile lytic lesion in left scapula, sparing the subcortical region. Breach of cortical continuity is noted in the lateral border, indicating pathological fracture. Mild soft tissue irregularity is also noted with displacement of fat plane. No calcification is noted within or outside the lesion. The articular surface is intact.
Low attenuated lytic and highly destructive lesion with erosion of the cortex is noted in the left scapula, involving the majority of supraspinatus and infraspinatous regions, including part of scapular spine. Cortical breach is noted, and the articular margin is somehow maintained. Some soft tissue involvement is also noted with displacement of intermuscular fat plane. The cortex has a specular margin which raises suspicion in favor of malignancy.
3D reconstruction of the scapula and left humerus shows a lytic pattern of lesion with exact location. The scapular blade is almost destroyed, demonstrating the highly destructive nature of the tumor.
Microscopic examination:
Anaplastic spindle cells arranged in a fascicular pattern with little intervening stroma.
Diagnosis:
Spindle cell sarcoma.
Case Discussion
Spindle cell sarcoma is a very rare form of malignancy, occurring mostly over age of 40. It may occur anywhere in the body but mostly affects long bones like humerus and femur. It also affects the pelvis and flat bones like the scapula.
There are different kinds of spindle cell cancers, which include pleomorphic undifferentiated malignant sarcoma, fibrosarcoma, and leiomyosarcoma. Additionally, undifferentiated sarcoma is common in head and neck regions.
Unable to process the form. Check for errors and try again.