Cytologically Yours: CoW: 20140206
The patient is a 12 year old female with a six month history of left shoulder pain. The patient had tried Aleve and had several chiropractic visits which were unsuccessful at relieving the pain.
Past Medical History
- Previously heathy
Past Surgical History
- No surgical history
- AP/Lateral images show a destructive and aggressive appearing lesion in the left proximal huerus in the metaphysis extending 7.5cm distally in the diaphysis.
The differential diagnosis included osteosarcoma and Ewing sarcoma. MRI and CT guided biopsy are scheduled.
- The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?
The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma.
- Positive for malignancy, the differential diagnosis includes melanoma and Hodgkin lymphoma.
- Conventional high grade sarcoma, sclerotic type.
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters.