Presentation
Unknown
Patient Data
There is a large lytic lesion involving the majorty of the scapular body, scapular spine and coracoid process. The lesion is poorly defined but expansile, and demonstrates extension into the surrounding soft tissues superiorly, anteriorly and posteriorly. There are thin whispy septations of calcific density scattered throughout the mass. There is a thin preserved area of articular glenoid bone, along with the vertebral border of the scapula, inferior angle and a portion of the axillary border, and the acromion process. There is no periosteal reaction observed. The clavicle, humerus and chest wall appear uninvolved.
There is a large, expansile, loculated cystic lesion extending from the scapula circumfrentially, but most prominently anteroposteriorly. There are multiple fluid-fluid levels, with scattered heterogenous areas that are less well defined. There is diffuse enhancement of the dividing septa, as well as some of the soft tissues posterior to the lesion.
Case Discussion
This case most likely represents a large telangiectatic osteosarcoma, but could also represent a large aneurysmal bone cyst secondary to a giant cell tumor. The patient was lost to followup.
This case is courtesy of George Matcuk, MD who generously shared it with me.
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