第50回BTC ‘13.12.7

K-1

Case History (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

第50回BTC ‘13.12.7

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.

第50回BTC ‘13.12.7

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

第50回BTC ‘13.12.7

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 5th 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.

第50回BTC ‘13.12.7

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

第50回BTC ‘13.12.7

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

第50回BTC ‘13.12.7

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

T2WI T1WI

第50回BTC ‘13.12.7

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