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Presented by Edward McCarthy, M.D. and prepared by Dengfeng Cao, M.D. Ph.D.
Case 4: A 50 year old man had pain in his knee for two months.
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1. Question
Week 196: Case 4
A 50 year old man had pain in his knee for two months. A radiograph demonstrated an extensive destructive lytic lesion occupying most of the shaft at his distal femur. A biopsy was performed.images/Cao_101604case4a.jpg
images/Cao_101604case4b.jpg
images/Cao_101604case4c.jpgCorrect
Answer: Malignant fibrous histiocytoma
Histology: Histologic features of this lesion are spindle cell/histiocytic type of sarcoma with extensive pleomorphism. These are the histologic features of malignant fibrous histiocytoma. Malignant fibrous histiocytoma is one of the most common primary bone sarcomas in older patients.
Discussion: The lesion is not metastatic carcinoma because of the absence of epithelial cells. Metastatic carcinoma should be a consideration, however, because it is the most frequent cause of the bone lesions in the elderly patients. The lesion is not an osteogenic sarcoma because there is no evidence of osteoid production.
Although there is extensive fibrous differentiation in this case, there is extensive atypia and numerous mitotic figures typical of a malignant tumor. Therefore this lesion is not a benign fibrous tumor such as non-ossifying fibroma.
Incorrect
Answer: Malignant fibrous histiocytoma
Histology: Histologic features of this lesion are spindle cell/histiocytic type of sarcoma with extensive pleomorphism. These are the histologic features of malignant fibrous histiocytoma. Malignant fibrous histiocytoma is one of the most common primary bone sarcomas in older patients.
Discussion: The lesion is not metastatic carcinoma because of the absence of epithelial cells. Metastatic carcinoma should be a consideration, however, because it is the most frequent cause of the bone lesions in the elderly patients. The lesion is not an osteogenic sarcoma because there is no evidence of osteoid production.
Although there is extensive fibrous differentiation in this case, there is extensive atypia and numerous mitotic figures typical of a malignant tumor. Therefore this lesion is not a benign fibrous tumor such as non-ossifying fibroma.
