In the right shoulder, a superficial, swollen, tender, somewhat erythematous mass is present. It measures 18 cm x 22 cm in anterior-posterior and medial-lateral dimensions. It is soft, slightly compressible, nonpulsatile, slightly tender. Portions of it are firm. It is fixed in position. However the range of motion of the shoulder is impaired. Distally, neurovascular status of the arm appears to be normal. Median, radial, and ulnar nerve function is normal. Radiographs show an expansile mass that is adjacent to the distal end of the clavicle and contains spiculated bone density material consistent with bone formation by a tumor. An MRI scan of the lesion shows a large expansile lesion in the area noted. The lesion extends into the rotator cuff, and there is involvement of the distal clavicle. It extends into the subacromial space. There is some extension between the deltoid and the posterior rotator cuff muscles down the back of the shoulder. The lesion has a multilobular appearance. CT scan of the chest, abdomen and pelvis shows multiple subtle pulmonary abnormalities and nodules, which are indeterminate, but could represent metastasis.