What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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Findings The radiographs show a marked area of sclerosis over a long area of the right femur with aggressive periosteal reaction which is even more conspicuous on the CT images. The CT otherwise again demonstrates marked sclerosis of the proximal right femur over a fairly long segment. The MRI shows prominent low signal of the proximal femur in keeping with the dense sclerosis but additionally edema extending into the adjacent bone and edema of the periosteum/periostitis. Only the one lesion of the right femur is identified.
What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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What’s the Diagnosis – Case 142
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Diagnosis: Prostate Metastasis The most common malignancy of bone to see in adults is metastatic disease but the appearance shown in this case can be a bit confusing. Many primary malignancies produce bony metastases (mets) and some have a proclivity for lytic mets, blastic mets, or a mixed pattern. Prostate cancer very typically gives blastic (sclerotic) mets but often they are rounded foci of dense productive bone. Occasionally, prostate mets can produce lesions as seen here with a large area of sclerosis and aggressive periosteal reaction. This appearance has a striking resemblance to osteosarcoma (OSA). OSA is a disease of younger patients from children to young adults. OSA is found in the older patient population but typically in the setting of underlying abnormal bone often previously treated with radiation or Paget disease of the bone. A bone producing malignancy would look very similar with dense bone, aggressive periosteal reaction, and surrounding edema of the bone and periostitis. It is interesting to note that in most blastic mets there is typically at least a small amount of surrounding edema in the bone. Given the somewhat atypical appearance of this lesion, an approach was performed to help preserve the posterior compartment of the hip if per chance this lesion was a primary malignancy of bone. This shows the need for inter disciplinary communication to provide the best treatment of patients as the approach was discussed with the referring clinician.
What’s the Diagnosis – Case 142
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