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hip and proximal femur

An inherited disorder with bone fragility

Case Identification
Case ID Number: 
20090629HK
Periosteal Reaction: 
absent
Benign/Malignant: 
Benign
Clinical case information
Case presentation: 

The patient is a 35-year-old woman who has pain in the top of the right proximal femur. The patient has a history of an inherited syndrome affecting growth and bone development.

Radiological findings:: 
She had precocious onset of sexual development. On examination the patient has short stature. There is a large café au lait spot over the right side of the neck and over the back. It has a regular border. See the xray images.
Laboratory results:: 
No contributory findings.
Differential Diagnosis: 
What is your differential diagnosis?
Treatment Options:: 
What should be done?

An pathologic fracture of the right femoral neck

Case Identification
Case ID Number: 
20100224PF
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient has a history of pain in the hip that dates back about two months. The pain became gradually worse and he had some small episodes of exacerbation. Recently he began using crutches. Then, he had another episode of a slight twisting injury with dramatic increase in the pain and was found to have a fracture.

Radiological findings:: 
He is 26 1/2 years old. He is otherwise generally healthy. The patient denies any fevers chills weight loss anorexia or other systemic symptoms. Abdominal examination shows no mass, and there is no inguinal lymphadenopathy. There is shortening of the right leg versus left of about 1 1/2 inches. There is pain with motion. There is no generalized swelling. Radiographs show a lytic destructive lesion in the right proximal femur which has a relatively sharp well marginated border and there is no definitive soft tissue mass. MRI shows a well defined mass in the femoral neck and head with bright signal on T2 and dark signal on T1, with very little reacive change and no apparent soft tissue mass. A workup shows no abnormaliy in the chest, abdomen, or pelvis other than what is shown. Bone scan shows this lesion appears to be solitary.
Laboratory results:: 
no significant findings
Image Reference: 

Aneurysmal Bone Cyst

Aneurysmal bone cyst (ABC) is a solitary, expansile and erosive lesion of bone. The cause of this non-neoplastic lesion is unknown.
Most patients are under 20, but the tumor can occur at any age.
The tumor presents with pain for several weeks with local swelling. Any bone may be involved, but the most common sites include the long bones and the posterior parts of the spinal vertebra.On xrays, the lesion has a destructive, lytic, and expansile appearance.
Most ABC's are sucessfully treated with curettage and packing with bone chips or bone cement.

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Borrar Condrosarcoma de la Célula

Borrar de la célula de cáncer es un tumor destructivo bajo grado de malignidad que se presenta en los adultos. condrosarcoma de células claras es poco común y representa alrededor del 2% de todos los condrosarcomas.
La mayoría de pacientes con diagnóstico de condrosarcoma de células claras estaban en tercera y cuarta décadas de la vida. localización más frecuente es en la epífisis. Los sitios más frecuentes de afectación son el fémur proximal, húmero proximal, fémur distal y la tibia proximal.
Los síntomas más comunes son dolor e inflamación, que generalmente son de larga duración. Puede haber limitación del rango de movimiento de la articulación afectada. En las radiografías, estos tumores están bien circunscritos lesiones mixtas escleróticas Lucent y con un aspecto activo.
El tratamiento y pronóstico: resección en bloque con un amplio margen de un hueso normal y el tejido blando es el procedimiento de elección.

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