Case report 727

A 19-year-old man complained of pain in the right upper arm in July 1984. He had no history of trauma. He refused to have a complete examination because the pain improved with analgesics. Although the patient visited our hospital with pain in the right arm in September 1986, he again was not fully followed. Four years after the initial symptoms, persistent pain and swelling of the right upper arm developed. In November 1988, roentgenographic examination of the right humerus and shoulder region revealed osteolysis and osteosclerosis of the shaft of the humerus with a partial cortical defect and extraskeletal new bone in the adjacent soft tissues (Fig. I A). A CT scan showed an intramedullary lesion, cortical thickening, and juxtacortical irregular bone formation, with a softtissue mass (Fig. 1 B, C). Focal accumulation of 99myc in the midshaft of the right humerus was observed on bone scinfigraphy. Laboratory data showed no abnormality, A biopsy of the humeral lesion was performed on 16 December 1988, showing a malignant tumor simulating small cell osteosarcoma or Ewing tumor. After three courses of chemotherapy with cis-diammine dichloroplatinum (CDDP) and doxorubicin hydrochloride, wide resection was performed on 8 February 1989. Two years after resection, neither local recurrence nor metastasis is discernable.