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A 35-year-old female presents to your office after incidental finding of a aggressive looking lytic lesion in her pelvis. She has no pain, is not pregnant, but states she has been losing weight over the last 6 months for an unknown reason. Bone scan shows significant uptake in the area of her pelvis. Immunohistochemistry stains positive for smooth muscle actin. Which of the following slides correlates to your expected findings on histology?
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Based on the patients history (unexplained weight loss) and bone scan, she has an aggressive lesion in her pelvis. Immunohistochemisty staining for smooth muscle actin suggests a tumor of smooth muscle origin - or a leiomyosarcoma. The prefix - "leio-" designates smooth muscle tumors. The histopathology presented in Figure A shows interlacing bundles of smooth muscle cells with variable uniformity, high nuclear/cytoplasmic ratio, and mitotic figures - consistent with leiomyosarcoma.
The two cited review articles by Berlin et al and Antonescu et al describe the clinical, radiographic, and histology of this disease as described above.
Figure B - Giant cell tumor
Figure C - Myeloma
Figure D - Osteosarcoma
Figure E - hyaline cartilage
Berlin O, Angervall L, Kindblom LG, Berlin IC, Stener B.
Skeletal Radiol. 1987;16(5):364-76. PMID: 3306938 (Link to Abstract)
Antonescu CR, Erlandson RA, Huvos AG.
Am J Surg Pathol. 1997 Nov;21(11):1281-94. PMID: 9351566 (Link to Abstract)
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HPI - 3 weeks of pain. Limping.
Based only on the radiographs, what is the most likely diagnosis?