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hip and proximal femur

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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Calculate fracture risk

Case Identification
Case ID Number: 
20100728FR
Periosteal Reaction: 
absent
Benign/Malignant: 
Malignant
Clinical case information
Case presentation: 

This very pleasant 55-year-old woman has a lump in the left breast and pain in the left hip. She found the breast mass 1 year ago, and it has gotten larger. She first noticed gradually increasing pain in the left groin 8 or 9 months ago. Now, the patient cannot walk without crutches. She has extreme pain with certain activities, and is taking large doses of narcotic pain medicines.

Radiological findings:: 
On past medical history, the patient had a benign lump removed from the right breast in the 1980s. She does not smoke. On oncologic examination, the patient does not appear chronically ill or cachectic. There is a mass, which is firm and nontender, in the left breast laterally which measures about 4 x 4 cm. On musculoskeletal examination, the right hip has a very restricted range of motion. Although the patient to walk, she is very great difficulty placing any weight on the right leg. She can sit, but she cannot lay back without bending the knee up because extending the right hip is very painful. From the flexed position, the hip can be gently abducted without too much pain. No masses palpable along the proximal femur or in the distal femur near the knee. Plain films show a lytic, permeative, destructive lesion that seemed to be centered in the cortex of the right femur just below the lesser trochanter. Part of the cortex is damaged. There is poorly defined lytic process extending into the intertrochanteric area and down the proximal portion of the femur for 8 or 10 cm. An MRI shows a permeative destructive lesion in the same location proximal right femur, with no soft tissue mass. The bone scan shows multiple abnormal areas of tracer uptake, the proximal femur as a large area of abnormal uptake, there are at least two lesions in the ribs, there are multiple scattered lesions in the right distal femur, and there is one lesion in the pelvis.
Special Features of this Case:: 
The risk of pathological fracture can be calculated according to a specific method, called the Mirel's score. What is the score and what is the risk of fracture?
Image Reference: 
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