case_images: PMC4423010_01
case_images: Core biopsy, vertebral body T11. The bone marrow is replaced by a malignant spindle cell neoplasm with streaming and distortion of tumor cells ((a), 4x). Intermediate magnification demonstrates areas of storiform configuration ((b), 20x). High magnification shows spindle cells with apoptosis and mitotic figures ((c), 100x).
case_images: CRIHEM2015-518307.001.jpg
case_images: PMC4423010_01_CRIHEM2015-518307.001.jpg
case_images: fig1
case_images: The core needle biopsy specimen showed pathologic findings consistent with high-grade malignant spindle cell neoplasm, favoring poorly differentiated sarcoma with 19 mitoses per 10 high-power fields (Figure 1). The spindle cells were arranged in a nonspecific storiform pattern with necrosis being present in about 50 percent of the tumor cells.
case_images: Side-by-side comparison of the biopsy and excisions. Core biopsy ((a), 20x) with CD20 ((b), 20x) compared to the laminectomy ((c), 20x) with CD20 ((d), 20x). The spindle cell's features are pronounced in the core biopsy, whereas the laminectomy specimen is much more typical of lymphoma.
case_images: CRIHEM2015-518307.002.jpg
case_images: PMC4423010_01_CRIHEM2015-518307.002.jpg
case_images: fig2
case_images: Additional staining which was retrospectively performed on the archival paraffin block from the initial biopsy confirmed that both CD20 and PAX5 were positive in the malignant spindle cells consistent with DLBCL diagnosis (Figure 2).