DrBloodmoney

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Take a guess at this one. I spent 1.5 hours grossing this beast today. Mostly because our saw sucks the cock-a-doodle-doo. Nice case though.

Distal end of the femur :: 36 year old male






and just for LA- this is a photo I googled of this lesion... don't look at the filename- it'll give it away.


 

Freestyle

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I like the rulers under the specimens... especially the high-speed, low drag Ninja Pathology.
 

geddy

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Hot anal pathology? :laugh: :laugh: :laugh: :laugh:
 

LADoc00

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Dude,

You need age, sex and a plain film AP would help.

Is the lesion centered in epiphysis? Your gross photos suck hair monkey nuts to be honest.

There are really only 3 bony lesions of the epiphysis: chondroblastoma in young men, giant cell tumor of bone in young women and LCH.

Hence, why the location, age and sex are so important.
 
OP
D

DrBloodmoney

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LADoc00 said:
Dude,

You need age, sex and a plain film AP would help.

Is the lesion centered in epiphysis? Your gross photos suck hair monkey nuts to be honest.

There are really only 3 bony lesions of the epiphysis: chondroblastoma in young men, giant cell tumor of bone in young women and LCH.

Hence, why the location, age and sex are so important.
Must have skimmed right over the line above the photo... no films yet, our radiology film library is slow. Per the report... metaphyseal.
 

LADoc00

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AndyMilonakis said:
oooh... ha ha ha LADoc00...one word for you. STFU! :laugh:
WTF, you STFU. Dude Im a leet streetfighter, Id mess u up fo sure.

 

LADoc00

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Periosteal Osteosarcoma or
Parosteal Osteosarcoma

Is there a string sign on the xray? I would consult with a radiologist and get an answer to that.
 

bananaface

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LADoc00 said:
WTF, you STFU. Dude Im a leet streetfighter, Id mess u up fo sure.
You have to totally pwn him, not partially pwn him.

Like this:
AndyMilonakis said:
Hey Andy...
 
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DrBloodmoney

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LADoc00 said:
Periosteal Osteosarcoma or
Parosteal Osteosarcoma

Is there a string sign on the xray? I would consult with a radiologist and get an answer to that.
I knew it wouldn't take you long.

Code:
Parosteal Osteosarcoma:

- See:
    - Bone Tumor Menu:
    - Classic Osteosarcoma

- Discussion:
     - parosteal osteosarcoma is a low-grade malignant bone tumor that usually occurs on the surface of
            the metaphysis of long bones;
     - arises between cortex and muscle as a low grade stage I-A surface tumor (ie does not initially
            invade underlying medullary canal);
     - most common in adolescents and yound adults;
     - parosteal osteosarcoma is distinguished from classic osteosarcoma
            by its much slower, less aggressive clinical course.
            - there is a low propensity to metastasize;
     - about 10% of parosteal tumors exhibit areas of dedifferentiation into
            high grade sarcoma & are thus considered stage IIb lesions.
     - tumor remains separated from normal bone, especially in the early stage;
            - extension into the underlying bone is associated with a higher incidence of dedifferentiation and pulmonary metastasis;
            - as growth continues, radiolucent zone between tumor & underlying bone may be obliterated as cortex becomes involved;
            - late in dz, tumor extends through the underlying cortex to invade medullary canal as well, converting to a stage Ib tumor;
            - invasion into the overlying displaced soft tissues is rare;
     - differential dx:
            - Osteochondroma;
            - myositis ossificans,
            - Periosteal chondroma,

- Location: often presents as a fixed, painless mass on:
      - proximal humerus is the second most common location;
      - posterior aspect of the distal femur (50% of cases);
            - in this location, its slow growth may result in late invasion of the underlying cortex as well as circumferential
                   growth around the anterior aspect of the femur;
            - when the tumor invades the canal, its stage changes from Ia to Ib;

- Radiographs:
     - dense, heavily ossified, broad based fusiform mass that appears to encircle the metaphysis.
      - tumor is separated from cortex by  thin, uninvolved, radiolucent zone;
      - medullary canal should not show tumor involvement;

- Histology:
     - irregular "matured" bony trabeculae;
     - osteoid trabeculae lie parallel to one another in a hypocellular stroma;
     - regularly arranged trabeculae have intervening spaces w/ atypical cells;
     - trabeculae have pattern of cement lines similar to those of Pagets Dz;
     - trabeculae may contain varying degrees of cartilage;
     - diff dx:
          - Fibrous Dysplasia;
               - surface location of parosteal osteosarcoma excludes dx of fibrous dysplasia;
          - parosteal osteosarcoma may be underdiagnosed as benign due to benign appearing histologic features;
          - dedifferentiation will have a worse prognosis;

- Treatment and Prognosis:
     - wide excision w/ limb salvage is treatment of choice;
           - prognosis is good & chemotherapy is not indicated;
           - w/ indication of inadequate margins or with tumor invasion into soft tissues will require postop XRT;
     - in the report by VO Lewis et al (J Bone Joint Surg [Am] 82-A: 1083-8, 2000), the authors report on a new
           technique for operative management of parosteal osteosarcoma located in the popliteal fossa;
           - method involves resection of the mass through separate medial and lateral incisions, which allows
                  for wide margins yet limits the amount of dissection of the soft tissues and the NV bundle. 
           - 6 patients with parosteal osteosarcoma located on the posterior aspect of the distal part of the femur
                  underwent resection of the lesion and reconstruction with a posterior hemicortical allograft through
                  dual medial and lateral incisions;
           - average time until the last follow-up assessment was 4.3 years.
                  - no metastases developed, and there were no local recurrences.
           - technique advantages:
                  - two incisions allow the surgeon to clearly visualize the sites of the osteotomies and to accurately define
                         the margins of the resection;
                  - NV bundle is easily dissected from the posterior aspect of the tumor;
                  - most of the distal femoral articular cartilage is salvaged and the joint remains stable;
I'll throw some h/e's up when this sucka gets done decaling.
 

deschutes

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Hmm. He's right, you know.

I thought one would have to set overflow parameters and all that sort of stuff.

This could potentially be extremely annoying. Something like this between two [ code ] and [ / code ] for instance:

< script type="text/javascript" >
< !--
alert("Hello world!");
//-- >
< /script >
 

LADoc00

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Parosteal are more likely in women, but the extremely dense calification is def. consistent with this. If it were boards, I would gone parosteal because its one those "good prognosis" osteosarc's everyone has to be able to recognize and thus is always on the boards.

There be a string sign on the xray you posted or no? That really is my main thing I look for.
 
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DrBloodmoney

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Yeah in early to mid stage lesions there is supposed to be a radiolucency between the lesion and the cortical bone. This one was pretty classic though. You could probably diagnose osteosarc on the gross... there is definite osteoid formation in the this pic:



Anyways good news for this guy.