Orthopaedic MD

Case Report Indian Journal of Surgery 66(6)2004

From Applied Radiology General Approach to Lytic Bone Lesions Posted 05/21/2004 D. Lee Bennett, MD, MA; Georges Y. El-Khoury, MD Abstract and Introduction Abstract When interpreting musculoskeletal radiographs, a radiologist must be able to identify a lytic lesion and provide a definitive diagnosis or a reasonable differential diagnosis for the lesion. This article addresses these issues and details a rational and systematic approach to such lesions. Medscape

Giant Cell Tumor Last Updated: June 6, 2002 Author: Lesley-Ann Goh, MBBS, FRCR, Consultant, Department of Diagnostic Radiology, National University Hospital Coauthor(s): Wilfred CG Peh, MBBS, MHSM, MD, FRCPE, FRCPG, FRCR, Clinical Professor, Faculty of Medicine, National University of Singapore; Senior Consultant Radiologist, Programme Office, Singapore Health Services; Tony WH Shek, MBBS, FRCPA, Honorary Clinical Assistant Professor, Department of Pathology, University of Hong Kong Background: Giant cell tumor of the bone is a relatively uncommon tumor. It is characterized by the presence of multinucleated giant cells. The tumor is usually regarded as benign. In most patients, giant cell tumors have an indolent course, but tumors recur locally in as many as 50% of cases. Metastasis to the lungs may occur. Cooper first reported giant cell tumors in the 18th century. In 1940, Jaffe and Lichtenstein defined giant cell tumor more strictly to distinguish it from other tumors. Giant cell tumor usually occurs de novo but also may occur as a rare complication of Paget disease of the bone Introduction Differentials Radiograph CT Scan MRI Nuclear Medicine Angiography Pictures Bibliography

BoneTumor.org Giant cell tumor accounts for 5 to 9 percent of all primary bony tumors and may be the most common bone tumor in the young adults aged 25 to 40. Giant cell tumor is are found more commonly in women than men, and occur most often during the third decade (1). Giant cell tumors are usually found in the long bones, most often the distal femur, proximal tibia, and distal radius. Giant cell tumor is a one of the most common primary bone lesions in the distal phalanx. Whether that tumor arises in the epiphysis or distal metaphysis is a matter of controversy, but giant cell tumors only occur after the epiphyseal plates have closed and a diagnosisof GCT in a patient with open growth plates should be questioned.

Discussion: - a common benign but locally aggressive lesion of unknown etiology; - occurs chiefly in men between 20-50 yrs (after epiphyseal closure); - tumor is expansile lytic lesion that involves the epiphysis & metaphysis; - tumor may enlarge to occupy most of epiphysis & adjacent metaphysis; - tumor may erode & penetrate subchondral bone, articular cartilage, & cruciate ligaments;

Introduction Relevant Anatomy And Contraindications Workup Treatment Outcome And Prognosis Pictures Bibliography Introduction Giant cell tumors of the tendon sheath are the second most common tumors of the hand, with simple ganglion cysts being the most common. Chassaignac first described these benign soft-tissue masses in 1852, and he overstated their biologic potential in referring to them as cancers of the tendon sheath. Giant cell tumors of the soft tissue are classified into the common localized type and the rare diffuse type. The rare diffuse form is considered the soft tissue counterpart of diffuse pigmented villonodular synovitis (PVNS). The diffuse form typically affects the lower extremities. Its anatomic distribution parallels that of PVNS, with lesions most commonly found around the knee, followed by the ankle and foot. However, the diffuse form occasionally affects the hand. Typically, these lesions, like those of PVNS, occur in young patients; the condition is diagnosed in one half of the patients before they are aged 40 years. The diffuse form is often locally aggressive, and multiple recurrences after their excision are common. Because of the similarity in patients' ages, tumoral locations, clinical presentations, and symptoms in PVNS and the diffuse form of giant cell tumors of the tendon sheath, the diffuse form probably represents an extra-articular extension of a primary intra-articular PVNS process. Findings from flow cytometric DNA analysis suggest that PVNS and giant cell tumors of the tendon sheath are histopathologically similar but clinically distinct lesions. When the origin of these poorly confined soft-tissue masses is uncertain, Enzinger and Weiss classify these tumors as the diffuse type of giant cell tumors of the tendon sheath, whether or not they involve the adjacent joint. This article focuses on the common localized form of giant cell tumors, that is, the giant cell tumors of the tendon sheath that often are found in the hands and feet. Author: James R Verheyden, MD, Consulting Surgeon, Department of Orthopedic Surgery, The Orthopedic & Neurosurgical Center of the Cascades Coauthor(s): Timothy A Damron, MD, David G Murray Professor, Department of Orthopedic Surgery, Upstate Medical University; Professor, Orthopedic Oncology and Adult Reconstruction, Department of Orthopedics, State University of New York at Syracuse eMedicine 2002

marrow lesion menu

Heterotopic Bone Formation/Ossification (HO)

Full text account of progression of the condition in a patient who refused initial treatment Singapore Medical Journal 2003 Vol 44 (7)

Experience with 10 cases of Osteoclastoma (Giant Cell Tumour) in different locations

Pathology Update Pathologic and Radiologic Features of Primary Bone Tumors from Cancer Control: Journal of the Moffitt Cancer Center Douglas Letson, MD, Robert Falcone, PA, and Carlos A. Muro-Cacho, MD Introduction Primary bone tumors are comparatively rare and, therefore, physicians rarely accumulate enough experience in the management of these neoplasias. Due to the complexity in radiologic and histopathologic appearances and the serious consequences of inappropriate surgical treatment, clinical management of bone tumors is best achieved through a multidisciplinary approach. Cancer Control 6(3):283-293, 1999 Medscape

marrow lesion menu

Six categories of questions including questions on sites, pathology, terminology and treatment. From Bonetumor.org

Wheeless' Textbook of Orthopaedics

An introductory table provides an overview for common locations for tumors and tumor-like lesions of the bone. Text with radiographs and pathology images describe each tumor type. By Dr. Mellors of the Weill Medical College of Cornell University.