Case History K-1 (Kyung Hee University, S12-00829) A 17-year-old male presented with posterior neck pain and numbness in both upper extremities after a diving injury. He had no relevant medical history. Physical examination revealed normal muscle strength but decreased sensation in both upper extremities. T1- weighted image shows an expansile hypointense mass that was centrally located in the posterior osseous element of C3. T2-weighted image demonstrates spinal cord compression caused by an epidural extraosseous extension of the mass and kyphotic angulation. This tumor eroded left transverse foramen and contact with vertebral artery. Submitter: Yong-Koo Park Department of Pathology, Kyung Hee University College of medicine, Seoul, KOREA
J-1 9-month-old female baby Taichiro Yoshimoto, Hiroki Imada, Hirotoshi Kawata, Takehiko Yamaguchi Department of Pathology, Jichi Medical University, JAPAN [Clinical Summary] A 9-month-old female baby who has suffered from WHIM (Warts, Hypogammaglobulinemia, infections, and Myelokathexis) syndrome has noticed to show asymmetric contour of the face since her birth. At her age of 2 months, Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) revealed a relatively well-demarcated, expansile, osteolytic lesion in right part of the mandible, measuring 28 mm in diameter. About six months later, she was admitted to our hospital because the lesion had become larger, gradually. MRI showed a floating tooth sign suggestive of Langerhans cell histiocytosis (LCH). She underwent excisional biopsy.
K-2 Case History A 15-year old female patient was visited Korea Cancer Center Hospital for further evaluation and management of her right knee pain. Brief history is as follows: March 16, 2013; Right knee pain was developed March 27, 2013; Biopsy was performed and diagnosed as aneurysmal bone cyst April 4, 2013; Patient was transferred to our hospital and secondary biopsy was performed (slide 1) July 15, 2013; Segmental resection of right distal femur was done (slide 2) Submitter: Jae-Soo Koh Department of Pathology, Korea Cancer Center Hospital, KIRAMS, KOREA AP view before biopsy AP view before resection
J-2 15-year-old girl with an exostosis of the rib Akihiko Yoshida Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, JAPAN [Clinical Summary] The patient presented with an exostosis of the left 5 th rib, which had been followed by annual CT scan for 3 years (see X-ray and CT) without showing significant changes. The patient had no past medical history or family history. She was asymptomatic. The tumor was not palpable. The tumor was resected with the adherent overlying parietal pleura, and it has not recurred 2 years after the surgery. [Gross Findings] The specimen consisted of a 6 cm segment of rib with a 2 cm exostosis in the middle. Sectioning revealed a 0.9 cm ill-defined gray nodule within the exostosis. The lesion was decalcified by EDTA and entirely submitted for examination. A representative slide is provided.
K-3 Clinical History (Y.U.H. S13-16669) A 72-year-old man presented with the left cheek swelling for 20 days. He had been suffering from psoriasis. He had pulmonary embolism due to deep vein thrombosis in 2006 and left knee total arthroplasty surgery in 2010. MR images showed a large soft tissue mass in the left parapharyngeal space. This mass was extended to the left masticator and parotid spaces. On PET/CT scan, the left parapharyngeal mass showed increased 18F-FDG (fluorodeoxyglucose) uptake. The right thyroid gland showed increased 18F-FDG uptake lesion. Excision of the left parapharyngeal mass was performed one month after aspiration cytology and needle biopsy. Grossly, the mass measured 7 x 6 x 5 cm. The cut surface was circumscribed and partly infiltrative, yellow-gray, rubbery soft, focally hemorrhagic. Submitter: Joon Hyuk Choi Department of Pathology, Yeungnam University College of Medicine, Daegu, KOREA
J-3 Ryo Shibuya, Masanori Hisaoka Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, JAPAN [Clinical Summary] A 40-year-old man who presented with a 6-month history of a mass in the left sole was admitted to a regional hospital. There was no clinical history of radiation exposure or radiotherapy, and the family history was unremarkable. Radiographic examinations, including plain X-ray films, computed tomography scan, magnetic resonance imaging and FDG-PET scan showed four distinct nodular lesions, ranging from 1.5 to 2.0 cm in the left lower extremity (two in the posterior aspect of the left lower leg, two in the left foot), together with multiple lymphadenopathies in the left groin. After percutaneous needle biopsy of the lower leg, the tumors were surgically removed. Post-Contrast T1WI Post-Contrast fat suppressed T2WI
K-4 Clinical History (St. Vincent Hospital S13-16935) A 76-year-old woman presented with huge mass in the inner side of left thigh exists for 10 years. She has been take medication for hypertension. This mass was movable, rubbery, and non-tender. It was measured about 12.4x10.0cm. On MRI, this tumor was a large lobulated soft tissue mass confined within subcutaneous fat tissue and showed heterogenous signal intensity. Intramuscular involvement was absent. Grossly, this tumor was well circumscribed, and pale yellowish rubbery cut surface. Hemorrhage and cystic change were also noted. Tumor extirpation was performed. Submitter: Changyoung Yoo Department of Pathology, The Catholic University of Korea St. Vincent Hospital, Suwon, KOREA T1WI T2WI
J-4 Tumor in the distal thigh Kunio Iura, Kenichi Kohashi, Yuichi Yamada, Akira Maekawa, Yusuke Takahashi, Hidetaka Yamamoto, Yoshinao Oda Department of Anatomic Pathology, Kyushu-University, JAPAN [Case] 33 y.o. F [Chief Complainment] Popliteal pain and mass [Current Medical History] The patient had complained of the left knee pain and had noticed a mass in the posterior side of the left distal thigh. MRI showed a 5 5cm-sized mass with iso intensity on T1- weighted images and high intensity on T2 weighted images, which located within the hamstring muscle. The patient underwent wide surgical resection. The cut surface was soft grayish-white and solid. Eleven years after the surgery, the tumor developed lung metastasis. The patient has remained disease-free for 4 years after the surgical resection and chemotherapy for lung metastasis. T1WI T2WI