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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2293 - 28 March 2019 Posted By: Raul Perret

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Clinical info: F in her 70s with a 22 cm thoracic wall mass surrounding the sternum. Previous history of metachronous bilateral breast cancer treated with surgery and radiotherapy


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Is that osteoid or collagen? The orange color is really interesting. I would say it's osteoid. So an osteochondrosarcomatous neoplasm. Of course, primary osteosarcoma at this age (70) is extremely unusual. So it comes down to a radiation-induced sarcoma or recurrent mammary metaplastic / sarcomatoid carcinoma. Would do a battery of cytokeratins, EMA, p63 to rule out the latter. Will need the clinical history to confirm radiation-induced sarcoma (field of radiation, when was the radiotherapy).

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Dr. Mona Abdel-Halim

Posted

10 hours ago, anh said:

Is that osteoid or collagen? The orange color is really interesting. I would say it's osteoid. So an osteochondrosarcomatous neoplasm. Of course, primary osteosarcoma at this age (70) is extremely unusual. So it comes down to a radiation-induced sarcoma or recurrent mammary metaplastic / sarcomatoid carcinoma. Would do a battery of cytokeratins, EMA, p63 to rule out the latter. Will need the clinical history to confirm radiation-induced sarcoma (field of radiation, when was the radiotherapy).

Agree

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Alex-Ventura-Leon

Posted

Yes, Osteosarcoma is my spot and for the age should be radiaton-induced.

Metaplasic Carcinoma or Malignant Phyllodes is a still a possibility so waiting for IHC.

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Raul Perret

Posted

Indeed this was a post-irradiation osteosarcoma showing chondroblastic, fibroblastic and osteoblastic differentiation. This are aggressive tumors and in the soft tissues, around 10% are estimated to be radio-induced. 

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