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A shoulder tumor that is poorly marginated

Submitted by henry on Mon, 07/27/2009 - 11:04
Case Identification
Case ID Number: 
20090727PM
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient is 29 and complained of pain and swelling in his left shoulder that was markedly swollen compared to the right. This had been present for nearly four years, and had gradually gotten worse over that time.

Radiological findings:: 
He worked as a cook, and had been essentially unable to use his arm for any work related activities for the past several months. Serpiginous, engorged superficial veins were prominent on the extremity. He had a firm, rubbery mass that was palpable over the lateral aspect of his proximal humerus, and extended distally nearly to his elbow. Several large, mobile axillary nodes were palpable.
Pathology results:: 
Photomicrographs from tissue similar to the biopsy materials are shown. There are crowded, irregular cells. The cytoplasmic border is well defined. Some of the nuclei show a cleaved appearance and there are large irregular cells with prominent nucleoli. Several mitoses are evident, and some cells are apoptotic.
Treatment Options:: 
1) What is your diagnosis? 2) What treatment would you recommend?
Special Features of this Case:: 
This patient presented with an extensive soft tissue tumor located adjacent to his left proximal humerus. It had been present for a number of years prior to his seeking medical attention, and by the time of presentation was quite extensive.
Image Reference: 
A shoulder tumor that is poorly marginated
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