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hip and proximal femur

Aggressive Fibromatosis (Desmoid Tumor)

Aggressive fibromatosis (AF)(desmoid tumor) is a rare tumor characterized by a monoclonal proliferation of fibroblasts in muscles, tendons, and ligaments. It is histologically benign, but may be locally aggressive, invasive, and destructive. The tumor does not metastasize but recurs frequently following treatment. The clinical presentation, anatomic location, and biologic behavior of this tumor are variable and an individualized treatment approach is required.




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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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