Case Identification
Case ID Number
Tumor Type
Body region
Position within the bone
Periosteal reaction
Benign or Malignant
Clinical case information
Case presentation
The patient is 53 and at around age 30, he developed a mass in his left neck. Since then he has had development of innumerable masses in the left arm, the left chest wall, and the left shoulder.
Radiological findings:
Prior to the developed mass at age 30, he did not have any arm or shoulder problems. He has had by his estimation, 23 surgeries. The lesions would become larger and larger and he would call the doctor who would arrange to remove the most symptomatic ones. His last surgery was about 13 years ago.
The patient is generally healthy. He does not have hypertension, diabetes, heart disease, and he has never been a smoker. He has had chemotherapy, which he describes as given in pill form, type unknown, as well as 4,500 cGy radiation therapy to the left chest, shoulder, and arm.
Recently, he has had onset of lymphedema. This seems to have developed in the last three to six months. He has had development of large tortuous veins on the chest wall and the proximal portion of the arm. Recently his symptoms have been worsening rapidly. The pain in the arm is unrelenting. The arm has become a useless, painful burden to him. He would like to have the arm amputated.
On the chest wall, there are dilated veins and erythema. However, there are no individual cutaneous tumors or hairy dark patches of skin. Clinical photos are shown.
The patient carries his arm in a makeshift sling. He has no useful motion of the arm. It is grossly swollen. There are multiple scars, as well as a thoracotomy scar. There are multiple palpable firm masses within the arm. The arm is exquisitely tender to the touch, and the dilated veins and areas of the chest wall adjacent to the arm are also quite tender.
There is an MRI available. There are multiple nodular masses within the left upper extremity. Xrays show pathologic fracture of the humerus and extreme lytic destruction of the bone.
The patient is generally healthy. He does not have hypertension, diabetes, heart disease, and he has never been a smoker. He has had chemotherapy, which he describes as given in pill form, type unknown, as well as 4,500 cGy radiation therapy to the left chest, shoulder, and arm.
Recently, he has had onset of lymphedema. This seems to have developed in the last three to six months. He has had development of large tortuous veins on the chest wall and the proximal portion of the arm. Recently his symptoms have been worsening rapidly. The pain in the arm is unrelenting. The arm has become a useless, painful burden to him. He would like to have the arm amputated.
On the chest wall, there are dilated veins and erythema. However, there are no individual cutaneous tumors or hairy dark patches of skin. Clinical photos are shown.
The patient carries his arm in a makeshift sling. He has no useful motion of the arm. It is grossly swollen. There are multiple scars, as well as a thoracotomy scar. There are multiple palpable firm masses within the arm. The arm is exquisitely tender to the touch, and the dilated veins and areas of the chest wall adjacent to the arm are also quite tender.
There is an MRI available. There are multiple nodular masses within the left upper extremity. Xrays show pathologic fracture of the humerus and extreme lytic destruction of the bone.
Treatment Options:
Given what you know, what treatment options are appropriate for this patient?
Image
Case ID Number
Image Types
Image modality
Tumor Name
Tumor Type
Benign or Malignant
Body region
Location in the bone
