DAVID R. LUCAS
University of Michigan
Ann Arbor, MI
A 21-year-old man with hereditary multiple exostosis (HME) presented with new-onset pain and swelling
in his left leg. Radiographs disclosed a large osteochondroma that formed a synostosis between the
proximal fibula and tibia. The gross resection specimen contained a 10 cm ostechondroma with a
lobulated cartilage cap, which varied from 0.2 to 2.0 cm in thickness. Destructive involvement of the
stalk was not present, and there was no gross evidence of peripheral soft tissue invasion.
GENE P. SIEGAL
University of Alabama
Birmingham, AL
A 55 year old Caucasian woman presented with headache and neck pain of three months duration. She was
otherwise in excellent health without known major illnesses or surgeries. A course of antibiotic therapy
did not relieve her pain. A subsequent trial of steroids was similarly unsuccessful in alleviating her
symptoms.
Three weeks prior to admission she developed blurred vision and "double vision" with drooping of her
left eyelid. On physical examination she appeared healthy but with ptosis of her left eyelid with
inhibition of both lateral and medial gaze. An MRI examination was performed which revealed a 4 cm mass
replacing the sphenoid sinus and extending into the nasal pharynx while compressing and laterally
displacing both internal carotid arteries. The upper tumor margin was seen to be at the level of the
optic chiasm. On a T1 weighted image the signal intensity was isointense to muscle but heterogenous.
The heterogeneity was slightly increased in its intensity on FLAIR and T2 weighted views.
Following intravenous contrast, the lesion demonstrated homogenous enhancement. Replacement of the
cavernous sinuses was noted and the lesion was seen to be slightly larger on the left at the upper margin
and eccentrically expanded to the right-inferiorly. The left wing of the sphenoid was enhanced as was
the tuberculum sella. The brain parenchyma was viewed as normal throughout.
On maxillofacial CT of the sinuses diffuse changes were seen in the skull bones. A large soft tissue
mass was again appreciated involving the sphenoid bone, including its body, greater and lesser wings, and
pterygoids and the lesion was also seen to extend into the right nasal cavity. Marked hyperostosis of
the posterior ethmoid sinus, mainly on the right, with a mass-effect on the posterior aspect of the nasal
septum (causing deviation to the left) was further appreciated. Taken together the changes were thought
to favor the diagnosis of a meningioma radiologically within the sphenoid sinus and pitutitary fossa.
Nasal endoscopy demonstrated a bulging of the posterior nasal cavity inferior to the sphenoid sinus
and superior to the nasopharynx. This mass was smooth and mucosally covered with a thin shell of bone
over the neoplasm. The tumor was white, and fleshy with minimal vascularity. Following endoscopic
evaluation she underwent a biopsy of the mass.
ANDREW HUVOS
Memorial Hospital for Cancer
New York, NY
This is a destructive lytic intramedullary lesion of the right proximal femur in a 7 year old girl.
Imaging workup showed a 9cm intramedullary metadiaphyseal tumor with cortical penetration and adjacent
soft tissue extension. There were no skip lesions nor were any other bones affected. No pulmonary
metastases were demonstrable.
An open biopsy was performed with appropriate immunohistochemical
panel, electron microscopic analysis as well as RT-PCR study.
ANDREW G. ROSENBERG
Massachusetts General Hospital
Boston, MA
A 64 year old woman presented to her physician complaining of a 1 year history of headaches and
diplopia. The symptoms had become progressively more severe during this time period. Radiographic
imaging studies revealed a focally calcified, well circumscribed mass in the region of the clivus that
impinged upon the brain stem. A biopsy was performed.
K. KRISHNAN UNNI
Mayo Clinic
Rochester, MN
22-year-old man presented with pain in the lower back and constipation. Roentgenograms revealed a
mineralizing mass involving the coccyx.
