Case Presentation

The patient is 61. He has had a long-standing problems with his knee, and his hips have been acting up. A recent radiograph showed a lesion in the left proximal femur.

On general examination, the patient is alert and oriented times 3. There is no café au lait spot, or other unusual skin lesion. The patient does not appear chronically ill or cachectic.

Examination of the hips shows bilateral limitation of internal rotation and stiffness. There is no mass in the left hip, and no tenderness over the proximal femur. No lymphadenopathy is present at the inguinal area.

The patient has x-rays made. In the proximal femur on the left, at the level of the lesser trochanter, there is a lesion, but the radiographic studies do not allow a firm diagnosis to be made.

Since this lesion cannot be characterized by radiological studies alone, a biopsy is necessary. This lesion is deeply placed within the musclular envelope of the thigh. Its location in the proximal femur is also a place where the mechanical loads are extremely high. Therefore, the potential mobidity of conventional open biopsy is very high. There is a high risk of fatigue fracture due holes in the bone made for the purpose of biopsy.

Biopsy must be accomplished in the safest manner possible without violating uninvolved tissue areas. Bone lesions of this type can be difficult for the pathologist to diagnose based on limited tissue samples, so needle biopsy has considerable high rate of failure due to nondiagnostic material.

What approach and method of biopsy should be used?

Think about your own approach and look at our recommendation here.




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