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A 49 year old woman with an enlarging calcaneal mass - 2

Case Identification
Case ID Number: 
20120116AA
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient reports an enlarging mass in the left foot for 2 years. Apparently it was small 2 years ago and now is quite substantial. An open biopsy was done, and resection is now planned.

Radiological findings:: 
There is a bony and cartilagenous mass on the plantar lateral surface of the calcaneus. Once the surrounding tissues are freed, the mass measures more than 8 cm. from base to the most distal point (arrows). At the base is a stalk at its base where the cortex of the bone and the lesion are confluent. The normal trabecular bone of the medullary portion of the calcaneus continues into the lesion. There is thick cap with several large lobules of cartiagenous tissue at the furthest extent definitely more than 2 cms thick (see images). Osteotomy is carried out through normal bone within the body of the calcaneus, resecting the entire stalk of the lesion and its cap en bloc.
Differential Diagnosis: 
chondrosarcoma vs osteochondroma
Special Features of this Case:: 
Lingering concerns about the nature of this lesion necessitated an ample incision for complete exposure and an aggressive resection.However, the peroneal tendons (arrows), a portion of the plantar fascia (arrow), and the tuberosity of the calcaneus were spared, and primary closure was achieved without difficulty.

A 55 year old Greek woman with foot pain and a bone lesion

Case Identification
Case ID Number: 
20110329GW
Benign/Malignant: 
Benign
Clinical case information
Case presentation: 

The patient is a 55 y.o female with pain on the base of the 1st metatarsal. She has difficulty on weight bearing leading to an antalgic gait.

Radiological findings:: 
The patient is a 55 y.o female with pain on the base of the 1st metatarsal (in the medial part of the midfoot). She has difficulty on weight bearing leading to an antalgic gait. There was a good response to NSAID medication, but the pain recurs as soon as she stops the medication. Symptoms have been going on for 3 months.

A boy who has taken aspirin every day for two years

Case Identification
Case ID Number: 
20090721TA
Benign/Malignant: 
unknown

A giant cell tumor totally destroyed the right proximal humerus

Case Identification
Case ID Number: 
20100421TD
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 32 year old patient had a giant cell tumor in her right proximal humerus. The AP radiograph and a radiograph taken after the biopsy are shown. Wide resection of the tumor was chosen because the lesion had destroyed too much of the bone and could not be treated with conventional curettage and packing with cement or bone graft.

Treatment Options:: 
What mode of reconstruction for the resulting bone defect will result in the best range of motion of the shoulder according to the literature? What are the three most common complications that may occur following this type of reconstruction?
Special Features of this Case:: 
This case shows a benign tumor which has created a very large defect and the resulting reconstruction is extensive. However, the patient is quite young, and has an excellent prognosis for survival, so the reconstruction chosen must be very durable and the need for reoperations should be avoided. The choice of technique is influenced by the survival probability.
Image Reference: 
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