Presentation
The patient presented with right leg pain.
Patient Data
A large, enhancing soft tissue mass with bony destruction of the sacrum extends anteriorly into the pelvis.
A large, soft tissue density mass with bony destruction of the sacrum extends anteriorly into the pelvis. Small areas of calcification are seen within this mass.
Gross pathology
Sacral mass: multiple brown/tan core fragments measuring 0.2 to 1.6 cm
Microscopic evaluation
Immunohistochemistry stains for pancytokeratin, GCDFP-15, SATB-2, Ki67, P63, and SOX-10 were utilized with adequate control in the evaluation of the biopsy.
Pancytokeratin, GCDFP-15, and SOX-10 are negative. SATB-2 and P63 are positive. The Ki67 proliferation index is significantly up to 25%.
The morphologic features and the immunohistochemical staining pattern support the diagnosis of a giant cell tumor of the bone.
An additional immunohistochemical stain shows nuclear positivity of the neoplastic cells for H3G34W, supporting the diagnosis.
Case Discussion
Imaging findings of a biopsy-proven giant cell tumor of the sacrum. The location in the sacrum is atypical, accounting for 2-8% of cases. The tumor is often locally aggressive. Treatment of giant cell tumors often involves surgical resection.
The case is courtesy of Dr. John Grosel, LucidHealth Radiology, and Interventional Associates.
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