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Presented by Edward McCarthy, M.D. and prepared by Anil Parwani, M.D.,Ph.D
Case 1: A 15 year old boy had a lump in his upper arm which was increasing in firmness over the past several months.
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Question 1 of 1
1. Question
Week 111: Case 1
A 15 year old boy had a lump in his upper arm which was increasing in firmness over the past several months. A radiograph demonstrated a well defined radiodensity in the area of his biceps muscle.images/102102case1fig1.jpg
images/102102case1fig1.jpg
images/102102case1fig1.jpg
images/102102case1fig1.jpg
images/102102case1fig1.jpgCorrect
Answer: Heterotopic ossification
Histology: The radiograph shows a well defined radiodense mass. The trabecular pattern of the radiodensity indicates that the lesion is composed of bone. Histologically, there is osteoid deposition in a cellular fibrous tissue stroma. There is a distinct zonal pattern i.e. the bone is more dense at the periphery of the lesion. The central cellular area shows a distinct “tissue culture-like” appearance. Although the stromal is cellular, there is no evidence of pleomorphism or atypical mitotic figures.
Discussion: The lesion is not an osteogenic sarcoma because of the lack of atypia and abnormal mitotic figures. In addition, the zonal pattern is an indicative of an non-neoplastic, reactive disorder. Zonal patterns are not present in osteogenic sarcoma.
The lesion is not a chondrosarcoma. Although the radiograph may raise the possibility of a cartilage tumor, there is no cartilage in the lesion.
Incorrect
Answer: Heterotopic ossification
Histology: The radiograph shows a well defined radiodense mass. The trabecular pattern of the radiodensity indicates that the lesion is composed of bone. Histologically, there is osteoid deposition in a cellular fibrous tissue stroma. There is a distinct zonal pattern i.e. the bone is more dense at the periphery of the lesion. The central cellular area shows a distinct “tissue culture-like” appearance. Although the stromal is cellular, there is no evidence of pleomorphism or atypical mitotic figures.
Discussion: The lesion is not an osteogenic sarcoma because of the lack of atypia and abnormal mitotic figures. In addition, the zonal pattern is an indicative of an non-neoplastic, reactive disorder. Zonal patterns are not present in osteogenic sarcoma.
The lesion is not a chondrosarcoma. Although the radiograph may raise the possibility of a cartilage tumor, there is no cartilage in the lesion.
