Primary Alveolar Soft Part Sarcoma of the Scapula
A 33-year-old male was referred to our institute complaining of right shoulder pain for the previous year due to a progressive tumor in the right scapular region. A swelling of the right shoulder was apparent during the physical examination. A lytic expansile scapular bone lesion with poorly distinguished margins and moth-eaten pattern was seen using standard X-ray imaging (fig. ). Multiple metastatic pulmonary nodular opacities were apparent on the chest radiogram (fig. ). The presence of a heterogeneous soft tissue mass within the right scapula was demonstrated by contrast-enhanced computed tomography (CT), resulting in expansion and destruction of the bone cortex (fig. ). An expanded and disrupted bone cortex was revealed by bone window level axial CT imaging (fig. ). An osseous soft tissue mass originating in the right scapular region and involving the glenohumeral joint and supraspinatus muscle was revealed by magnetic resonance imaging (MRI) with a tubular signal void of both the T1-weighted coronal (fig. ) and T2-weighted fat-suppressed axial (fig. ) images due to characteristic enlarged blood vessels; T1-weighted fat-suppressed coronal images were modified by heterogeneous contrast enhancement (fig. ). Ultrasound-guided Tru-Cut biopsy of the scapular lesion was performed, and the histopathology was consistent with ASPS and included positive periodic acid-Schiff (PAS) reaction of the cytoplasm in uniform cells with minimal pleomorphic nuclei (fig. ). Wide resection of the tumor (subtotal scapulectomy) was performed and the patient's shoulder pain resolved completely after surgery.