A 38-Year-Old Woman With an Osteolytic Rib Lesion

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A 38-Year-Old Woman With an Osteolytic Rib Lesion Javi Hartenstine, DO, Hope Jackson, MD, Keith Mortman, MD CHEST Volume 149, Issue 3, Pages e79-e85 (March 2016) DOI: 10.1016/j.chest.2015.12.010 Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 1 Initial CT scan of the abdomen and pelvis in the study patient revealing an incidentally found right ninth rib lytic lesion (circle). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 2 Chest radiograph confirming the presence of the lytic lesion (circle). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 3 CT scan of the thorax. (A) Axial and (B) Coronal images revealing an expansile lytic lesion (circles). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 4 Low-power view of fracture and fibrosis with cellular infiltrate and bone destruction. (Original magnification ×4). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 5 Low-power view of cellular medullary lesion and surrounding reactive fibrosis. (Original magnification ×4). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 6 Medium-power view of cellular infiltrate with intervening fibrous septae. (Original magnification ×10). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 7 Histiocyte demonstrating emperipolesis. (Oil emersion, original magnification ×100). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 8 CD-68 immunohistochemical stain results were positive on cellular membranes of histiocytes. (Original magnification ×20). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 9 S-100 immunohistochemical stain results were positive in nuclei and cytoplasm of histiocytes. (Original magnification ×40). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 10 CD1a immunohistochemical stain results were negative on histiocytes. (Original magnification ×20). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 11 CD68 immunohistochemical stain results were positive on cellular membranes of histiocytes. (Original magnification ×20). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 12 Differential diagnoses for solitary lytic bone lesions. ABC = aneurysmal bone cyst; GI = gastrointestinal; GU = genitourinary; MAI/MAC = Mycobacterium avium-intracellulare/Mycobacterium avium complex; UPS = undifferentiated pleomorphic sarcoma (new malignant fibrous histiocytoma). CHEST 2016 149, e79-e85DOI: (10.1016/j.chest.2015.12.010) Copyright © 2016 American College of Chest Physicians Terms and Conditions