MEETING No. 25, NOVEMBER 15th, G. PINI HOSPITAL, MILANO

Case 1
Case 2
Case 3
Case 4

Case 4

"A THIGH TUMOR"
A. PARAFIORITI - G. Pini Hospital - Milano
(Pictures by dr. A. Parafioriti)

Clinical history: an 81y.o. woman presents with a large, left proximal thigh mass; in the previous clinical history she refers a partial hysterectomy in 1965 for NOS “endometritis”.
X-ray, CT scan and NMR show that the neoplasia arises from the proximal femur where there is a pathological fracture and the tumor extends to the soft tissue of the thigh. The scintigraphy shows a single hot lesion in the skeleton in correspondence to the femur.
In another hospital a FNA was performed and the diagnosis was NOS mesenchymal neoplasia. The woman undergoes surgery for resection and prosthetic substitution of the proximal end of the femur.
A chest CT scan is negative, while ultrasound and CT scan of the pelvis are still to be performed.
Microscopic description: the spongy bone is infiltrated by spindled cells (pict. 1) - (pict. 2) arranged in intertwined fascicles and by pleomorphic, multinucleated cells (pict. 3) - (pict. 4) - (pict. 5).
Focally the spindled cells are in close continuity with round-oval epithelial cells, which occasionally present a solid-trabecular pattern around squamous pearls (pict. 6) - (pict. 7).
Immunohistochemical staining results: the spindled cells are strongly positive for Vimentin (pict. 8), mildly positive for Actin and Cam 5.2 the epithelial component is strongly positive for Cam 5.2 (pict. 9) and AE1-AE3 (pict. 10); mildly positive for EMA (pict. 11), CEA and Bcl2.
The other markers (CD34, CD31, Factor VIII, CD57, Desmin, protein S100, CD99, HBA71, alpha-fetoprotein) are negative.

Diagnosis

pict. 1	pict. 2
pict. 3	pict. 4
pict. 5	pict. 6
pict. 7	pict. 8
pict. 9	pict. 10
pict. 11

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