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Pediatric Case of the Day

¹ Departments of Radiology (R.J.C.)
² Pediatrics (E.B., Y.H.M.)
³ Pathology (M.E.V.), Medical College of Ohio, 3000 Arlington Ave, Toledo, OH 43614-2598.

View larger version (140K): [in a new window]   Figure 1a.  (a) Posteroanterior chest radiograph shows an expansile sclerotic lesion involving the left fifth rib. (b) Lateral chest radiograph shows an intrathoracic soft-tissue component.

View larger version (142K): [in a new window]   Figure 1b.  (a) Posteroanterior chest radiograph shows an expansile sclerotic lesion involving the left fifth rib. (b) Lateral chest radiograph shows an intrathoracic soft-tissue component.

View larger version (122K): [in a new window]   Figure 2. Figures 2, 3. (2) CT scan shows dense bone at the center of the tumor with bony spiculation primarily along the anterior margin. The soft-tissue component of the tumor extends through the vertebral foramen, displacing and compressing the spinal cord (arrow). R = right side of patient. (3a) Axial T2-weighted gradient-echo MR image (repetition time msec/echo time msec = 644/27; 25° flip angle) demonstrates the high-signal-intensity tumor within the spinal canal. The tumor is seen displacing and compressing the spinal cord, which has lower signal intensity (arrow). The area of high signal intensity in the soft tissue represents posterior extension of the tumor not seen at CT (cf Fig 2). (3b) Sagittal T2-weighted spin-echo MR image (2,700/120) clearly delineates the cranial and caudal extent of the tumor (arrows).

View larger version (97K): [in a new window]   Figure 3a. Figures 2, 3. (2) CT scan shows dense bone at the center of the tumor with bony spiculation primarily along the anterior margin. The soft-tissue component of the tumor extends through the vertebral foramen, displacing and compressing the spinal cord (arrow). R = right side of patient. (3a) Axial T2-weighted gradient-echo MR image (repetition time msec/echo time msec = 644/27; 25° flip angle) demonstrates the high-signal-intensity tumor within the spinal canal. The tumor is seen displacing and compressing the spinal cord, which has lower signal intensity (arrow). The area of high signal intensity in the soft tissue represents posterior extension of the tumor not seen at CT (cf Fig 2). (3b) Sagittal T2-weighted spin-echo MR image (2,700/120) clearly delineates the cranial and caudal extent of the tumor (arrows).

View larger version (160K): [in a new window]   Figure 3b. Figures 2, 3. (2) CT scan shows dense bone at the center of the tumor with bony spiculation primarily along the anterior margin. The soft-tissue component of the tumor extends through the vertebral foramen, displacing and compressing the spinal cord (arrow). R = right side of patient. (3a) Axial T2-weighted gradient-echo MR image (repetition time msec/echo time msec = 644/27; 25° flip angle) demonstrates the high-signal-intensity tumor within the spinal canal. The tumor is seen displacing and compressing the spinal cord, which has lower signal intensity (arrow). The area of high signal intensity in the soft tissue represents posterior extension of the tumor not seen at CT (cf Fig 2). (3b) Sagittal T2-weighted spin-echo MR image (2,700/120) clearly delineates the cranial and caudal extent of the tumor (arrows).

View larger version (181K): [in a new window]   Figure 4a.  (a) High-power photomicrograph (original magnification, x1,000; hematoxylin-eosin stain) shows a dense aggregate of small, uniform cells with poorly defined borders, inconspicuous cytoplasm, and round to oval nuclei. (b) High-power photomicrograph (original magnification, x1,000; immunoperoxidase stain) shows numerous cells with strong MIC2 immunoreactivity. The stain is localized mostly in the cell membranes.

View larger version (162K): [in a new window]   Figure 4b.  (a) High-power photomicrograph (original magnification, x1,000; hematoxylin-eosin stain) shows a dense aggregate of small, uniform cells with poorly defined borders, inconspicuous cytoplasm, and round to oval nuclei. (b) High-power photomicrograph (original magnification, x1,000; immunoperoxidase stain) shows numerous cells with strong MIC2 immunoreactivity. The stain is localized mostly in the cell membranes.