Vol 8 ppt
2 likes1,054 views
This document discusses various round cell tumors of bone, including Ewing's sarcoma. It provides details on 17 case studies of patients with Ewing's sarcoma located in different bones. It describes the clinical presentation, imaging findings, histology, treatment and outcomes of the cases. It also discusses other round cell tumors that can appear similar to Ewing's sarcoma, such as osteomyelitis, stress fractures, and eosinophilic granuloma.
Vol 8 ppt
- 1. Volume 8 Round Cell Tumors of Bone Ewing’s sarcoma-----------------Case 169-175 & 861-900 Large cell lymphoma------------Case 176-178 & 901-933 Hodgkin’s lymphoma-----------Case 179-180 & 934-936 Leukemia-------------------------Case 181 & 937-944 Plasma cell tumors Solitary plasmacytoma-------Case 182-185 & 946-957 Multiple myeloma------------Case 186-188 & 958-976 Metastatic neuroblastoma------Case 189 & 977-983
- 2. Round Cell Tumors Of Bone
- 4. Ewing’s Sarcoma The Ewing’s sarcoma is the second most common primary malignant bone tumor seen in children and is the fourth most common malignant tumor overall. This tumor is a very primitive mesenchymal sarcoma that has a mysterious etiology. However, with the advent of the electron microscope and immunohisto- chemical studies, most experts today feel that this tumor probably represents a poorly differentiated member of a larger family of neural tumors, distinct from the neuroblastoma. In 90% of cases, cytogeneticists will find reciprocal translocation in chromosome 11 and 22. That also is found in patients with the diagnosis of primative neuroectodermal tumor (PNET) and Askin’s tumor. Other round cell tumors that have a similar histological appearance include the embryonal rhabdomyosarcoma, the mesenchymal chondrosarcoma, and the metastatic neuroblastoma. It is very important to separate out the large group of histiocytic lymphomas
- 5. seen in an older age group that have a similar appearance with H & E staining. With special staining techniques, most lymphomas will be positive for leukocyte antigen. Likewise with metastatic embryonal rhabdomyosarcoma, specific immunohistochemical studies will reveal muscle markers such as actin, desmin, and myoglobin not found in the Ewing’s sarcoma. Ninety percent of patients with Ewing’s sarcoma will be from 5 to 25 years of age, with males being affected slightly more than females. The two most common locations for Ewing’s sarcoma are the femur and pelvis, followed by the tibia, humerus and scapula, but it can be found in any location in the body that includes myelogenous tissue, including the spine, ribs, foot and hand. Radio- graphically, the Ewing’s tumor will be found typically in a meta- diaphyseal location in the medullary canal with very diffuse, permeative lytic destruction of the surrounding cortical structures that looks like hematogenous osteomyelitis. Likewise, the clinical appearance of Ewing’s sarcoma can mimic infectious disease
- 6. with elevated temperature, white count and sed rate. Because of the high incidence of necrosis with the Ewing’s sarcoma, it is common to find liquefied necrotic debris in the tumor site that gives the clinical appearance of osteomyelitis. With early breakthrough into the subperiosteal tissues, the radiographic finding of a reactive periostitis is quite common, creating a multilaminated “onionskin” appearance on a routine radiograph. Another characteristic radio- graphic finding is the “hair-on-end” appearance that is created by reactive new bone formation along the perpendicular periosteal blood vessels running between the periosteum and the subadjacent cortex. Prior to 1970, the prognosis for survival in Ewing’s sarcoma was extremely poor with approximately 10% of patients surviving their disease. Currently with the use of adjuvant systemic chemotherapy in non-metastatic Ewing’s sarcoma, the survival prognosis now runs approximately 70%. However, in about 20% of patients with Ewing’s sarcoma that present with metastatic disease to other bones
- 7. or to the lung, the survival rate drops to about 30%. Whenever possible, the orthopedic oncologist will attempt a wide resection of the primary tumor site, a technique similar to that used for osteo- sarcoma. If wide surgical margins are obtained, the chances for survival is probably better than if radiation therapy and chemo- therapy had been used without surgery. However, in cases where the surgical margins are positive at the time of surgical resection, postoperative radiation therapy is indicated. The chance for local recurrence with chemotherapy and radiation therapy alone is 20% or higher. A devastating complication of radiation therapy is path- ological fracture that frequently results in intramedullary fixation that may fail and can result in amputation. Secondary sarcomas can occur with the use of radiation therapy for Ewing’s sarcoma in 10% of cases. The primative neuroectodermal tumor accounts for 10% of all Ewing’s-like tumors and carries the same prognosis for survival. The clinical management for this entity is essentially the same as for Ewing’s sarcoma.
- 8. CLASSIC Case #169 13 year female Ewing’s sarcoma distal femur onion skin periostitis
- 9. Bone scan
- 11. Coronal T-2 MRI
- 12. Coronal T-2 MRI showing multifocal disease
- 13. necrotic Macro section Ewing’s sarcoma distal femur viable
- 14. Photomic showing pseudo-rosette formations
- 15. Same patient with multifocal involvement proximal humerus
- 16. Case #170 15 year female Ewing’s sarcoma proximal tibia
- 17. Lateral view
- 18. Sagittal T-1 MRI
- 19. Axial T-1 MRI
- 20. Compress system Photo of resected proximal tibia & prosthesis
- 21. Placement of rotating hinge Compress prosthesis
- 22. Attachment of patellar ligament with double tooth washers
- 23. X-ray 2 mos post op anchor plug
- 24. 5.5 years post op with excellent osseointegration at bone-prosthetic interface
- 25. 11 years post op
- 26. Case #171 19 year female Ewing’ sarcoma proximal femur
- 27. Bone scan
- 28. 1 year later with path fracture thru radiated bone
- 29. Persistent non union after IM nailing
- 30. X-ray 1 year post op placement of cemented long stem custom bipolar prosthesis
- 31. Case #172 permeative lysis 13 year male with “hair-on-end”reactive subperiosteal new bone formation
- 32. Macro section resected proximal femur
- 33. periostium Closeup macro section showing “hair-on-end” necrosis reactive subperiosteal new bone permeation
- 34. periostium Closeup macro section “hair-on-end” subperiosteal reactive bone formation
- 36. Case #173 hair-on-end 15 year male Ewing’s sarcoma femur onion skin
- 37. Case #174 28 year male with Ewing’s sarcoma pelvis
- 38. tumor CT scan
- 39. Case #175 14 year male with Ewing’s sarcoma pelvis
- 40. ilium Macro section from tumor autopsy specimen acetabulum
- 41. Photomic
- 42. Case #861 34 year female with Ewing’s sarcoma pelvis
- 43. Close up hip
- 44. Coronal Gad contrast MRI
- 45. Coronal T-2 MRI
- 46. Axial T-1 MRI
- 47. Axial proton density MRI
- 48. Photomic
- 49. Case #862 Coronal T-1 MRI tumor 28 year male with Ewing’s sarcoma pubis
- 50. tumor Coronal T-2 MRI
- 51. tumor T-2 MRI
- 52. tumor Coronal T-2 MRI
- 54. Photomic
- 55. Axial PD MRI following successful chemotherapy
- 56. Coronal T-2 MRI post chemo
- 57. Case #863 10 year female with Ewing’s sarcoma pelvis
- 58. 6 months later
- 59. Coronal T-1 MRI
- 60. Coronal T-2 MRI
- 61. Case #864 19 year male with Ewing’s sarcoma SI area
- 62. Axial gad contrast MRI
- 63. Axial T-2 MRI
- 64. Photomic
- 66. Case #865 19 year male Ewing’s sarcoma sacrum
- 67. Close up
- 68. Myelogram showing nerve root pressure
- 69. tumor CT scan
- 70. Photomic
- 71. Case #866 12 year male Ewing’s sarcoma L-5
- 72. Oblique view
- 73. Case #867 37 year male Ewing’s sarcoma proximal femur
- 74. Coronal T-1 MRI
- 75. Photomic
- 76. X-ray allograft prior to implantation lateral AP
- 78. Case #868 14 year male Ewing’s sarcoma mid femur Bone scan
- 79. Coronal proton density MRI Pre chemo
- 80. Axial PD MRI pre chemo
- 81. Photomic
- 82. Axial PD MRI post chemo
- 83. Amputation following good chemo response
- 84. cement Post op x-ray with modified bipolar reconstruction
- 85. Case #869 21 year male with Ewing’s sarcoma pelvis and femur
- 86. Coronal T-1 MRI
- 88. Coronal T-2 MRI
- 89. Case #870 7 year male Ewing’s sarcoma distal femur
- 90. Bone scan
- 93. Photomic
- 94. Axial T-2 MRI post chemo
- 95. Coronal T-2 MRI post chemo
- 96. Case #871 13 year male Ewing’s sarcoma femur
- 97. 5 years after radiation & chemo with recurrence & path fracture
- 98. Post op x-ray with IM nail for path fracture
- 99. tumor bulge Total femur replacement specimen
- 100. Custom total femur replacement prosthesis
- 101. Placement of custom prosthesis
- 102. Post op X-ray
- 103. Case #872 16 year male Ewing’s sarcoma proximal femur
- 104. Lateral view
- 105. Coronal T-1 MRI
- 106. Coronal T-2 MRI
- 107. Axial proton density MRI
- 108. Case #873 9 year male with Ewing’s sarcoma tibia
- 109. Bone scan
- 110. Sagittal T-1 MRI T-2 MRI
- 111. Post op reconstruction allograft over IM nail
- 112. 8 years later
- 113. Case #875 onion skin laminated 2.5 year male periostitis Ewing’s sarcoma distal tibia
- 114. Lateral view entire tibia
- 115. Coronal T-1 MRI
- 116. Axial T-1 Gad contrast MRI
- 117. Case #876 17 year male with Ewing’s sarcoma tibia
- 118. Different view
- 119. Post op alloprosthetic allograft reconstruction
- 120. Multifocal lesion prox femur 6 mos later
- 121. Case #877 19 year female with tumor Ewing’s sarcoma proximal humerus hair on end
- 123. Case #878 39 year male Ewing’s sarcoma proximal humerus
- 124. X-ray one year later without treatment
- 125. Photomic
- 126. Case #879 10 year male with Ewing’s sarcoma scapula
- 127. Scapular view
- 128. Bone scan
- 129. CT scan
- 130. Special CT scan scapula
- 131. Case #880 9 year male with Ewing’s sarcoma scapula
- 132. Case #881 20 year male with Ewing’s of scapula
- 133. Soft tumor Special soft tissue technique x-ray
- 134. Case #882 16 year male with Ewing’s sarcoma clavicle
- 135. Case #883 16 year female with Ewing’s sarcoma clavicle
- 136. Case #884 7 year female with Ewing’s sarcoma 3rd posterior rib
- 137. Case #885 17 year female with Ewing’s sarcoma post 7th rib
- 138. Case #886 11 year male with Ewing’s sarcoma rib
- 139. Case #887 12 year female Ewing’s sarcoma fibula
- 140. Macro section from resected specimen
- 142. Higher power
- 143. Case #888 20 year female Ewing’s sarcoma distal fibula
- 144. tumor Axial T-2 MRI
- 145. Case #888.1 Ewing’s Fibula 15 yr male with pain and swelling of leg for 3 months
- 146. Cor T-1 T-2 Gad
- 147. Axial T-1 T-2 Gad
- 148. Case #889 15 year female Ewing’s sarcoma proximal fibula
- 149. Case #890 18 year male Ewing’s sarcoma distal fibula
- 150. Bone scan
- 151. Case #891 17 year male with Ewing’s sarcoma 4th metatarsal
- 152. Coronal T-1 MRI
- 153. tumor Axial T-1 MRI
- 154. tumor Axial T-2 MRI
- 156. CT scan thoracic spine shows multi focal lesion
- 157. Coronal CT scan
- 158. Case #892 35 year female with Ewing’s sarcoma os calcis
- 159. tumor Several months later
- 160. tumor T-1 MRI
- 162. Case #893 21 year male Ewing’s sarcoma mid tarsal area
- 163. Case #894 20 year male Ewing’s sarcoma 2nd toe
- 164. Case #895 5 year female Ewing’s sarcoma proximal ulna
- 165. Lateral view
- 166. Axial T-1 MRI
- 167. Sagittal T-1 MRI
- 168. Coronal T-2 MRI
- 169. Photomic
- 170. Case #896 50 year female with Ewing’s sarcoma proximal ulna
- 171. Case #897 2 year old with Ewing’s sarcoma middle finger
- 172. Lateral view
- 173. Sagittal T-1 MRI
- 174. Photomic
- 175. Case #898 15 year male with Ewing’s sarcoma thumb
- 176. Case #898.1 Parosteal Ewing’s sarcoma 18 year male with lateral knee knee for 3 months
- 177. Bone scan
- 178. Axial T-1 Axial Gad C+
- 179. Coronal STIR Gad C+ Sagittal Gad C+
- 180. Case #898.2 Parosteal Ewing’s sarcoma 13 year male with painful mass in forearm for 3 months
- 181. Bone scan
- 182. Cor T-1 T-2 FS
- 183. Sag T-1 Gad
- 184. Axial T-2 Gad Post chemo T-2 Gad
- 185. Case #898.3 Parosteal Ewing’s Sarcoma Humerus 27 yr female with firm tender mass in upper medial arm for 2 mos.
- 186. Axial T-2 Gad
- 187. Cor T-1 T-2 Gad
- 189. Case #899 onion skin periostitis 11 year female osteomyelitis distal femur looking like Ewing’s sclerosis sarcoma
- 190. Lateral view
- 191. Bone scan
- 192. Coronal T-2 MRI
- 193. Axial T-2 MRI
- 194. Photomic of reactive periostitis
- 195. polys lymphs Photomic showing inflammatory cells
- 196. Case #899.1 Ewing’s pseudotumor Osteomyelitis 3/06 7/07 7/07 14 year old male with pain right arm for 17 months
- 197. Cor T-1 T-2 Gad
- 198. Axial T-1 T-2 Gad
- 199. Case #900 8 year male with acute fracture thru prior femoral stress fracture stress periostitis Day of fracture
- 200. 3 days after acute fracture Stress periostitis
- 201. At 3 weeks looking like Ewing’s sarcoma
- 202. 6 mos later with solid union unlike Ewing’s sarcoma
- 203. Case #900.1 Stress Periostitis Radius Axial T-2 16 yr male with forearm pain for 6 weeks Gad
- 204. Case #900.2 Stress Periostitis Femur May June 10 yr male with pain in thigh for 2 months
- 205. Cor T-1 T-2 Sag T-2
- 206. Axial T-2 Axial CT
- 207. Case #900.5 Eosinophillic granuloma fibula looking like Ewing’s sarcoma in a 5 year male
- 208. Lymphoma of Bone
- 209. Lymphoma of Bone Lymphoma of bone accounts for approximately 7% of all primary malignant tumors of bone and can be divided roughly into two clinical groups: Hodgkin’s lymphoma of bone and non-Hodgkin’s lymphoma of bone. Hodgkin’s lymphoma carries a much better prognosis for survival. It tends to be localized and presents with a radiographic appearance that frequently includes a dense, sclerotic response. The non-Hodgkin’s lymphomas can be divided into two categories. The systemic form, the most common form with generalized involvement of the entire lymphatic system including soft tissue and bone, carries a poor prognosis. The less common form that is found in bone and does not have systemic manifestations carries a better prognosis for survival. To meet the strict criteria for a primary lymphoma of bone, the disease must be contained within the skeletal system for at least six months before becoming disseminated to other lymphatic organs such as lymph nodes and
- 210. spleen, at which time the prognosis for survival becomes much worse. The age group for primary lymphoma of bone is between 25 and 50 years. The most common bones involved are the spine and pelvis in 50% of cases. In the extremities, the most common location is the femur followed next by the humerus and tibia with multiple skeletal sites involved in approximately 25% of cases. Radiographically, the primary lymphoma takes on a permeative lytic appearance in cortical bone in a metadiaphyseal location, but can also involve epiphyseal bone as well. Because of the permeative nature of the bone destruction, pathologic fractures are common, similar to the situation with Ewing’s sarcoma. In both primary lymphoma and Ewing’s sarcoma, large soft tissue masses can be found. With H&E staining, the histological appearance of lymphoma and Ewing’s sarcoma can be quite similar but with specific immunohistochemical staining techniques, B cell and T cell subtypes of lymphoma can be identified and clearly separated from Ewing’s sarcoma. As in the case of Ewing’s sarcoma, the
- 211. advent of chemotherapy dramatically improved the prognosis for survival that, for a solitary primary lymphoma of bone, is similar to Ewing’s sarcoma with a 70% five year survival. However, with more disseminated involvement of multiple bones or other lymphatic organs, the prognosis drops dramatically to 10-25%. As with Ewing’s sarcoma, the lymphoma of bone is quite sensitive to external beam radiation therapy. However, the complications (including path- ological fracture) are a problem and the orthopedic oncologist will attempt a wide resection of the tumor if possible or, in more extensive involvement, an intralesional approach with a long stem cemented prosthesis with adjuvant bone cement may be indicated to avoid pathological fracture. In cases of systemic involvement with extensive metastatic disease, patients can be considered for bone marrow transplantation. The same holds true for Ewing’s sarcoma.
- 212. CLASSIC Case #176 45 year male lymphoma proximal femur path fracture
- 213. Frog leg lateral
- 215. tumor Coronal T-1 MRI
- 217. Axial T-2 MRI
- 218. High power photomic showing folded nuclear forms
- 219. Case #176.1 Large cell lymphoma 47 yr old male smoker with 4 mo history of left hip pain
- 220. Bone scan
- 221. Coronal T-1 T-2
- 222. Axial T-1 T-2
- 223. Post op recon nailing
- 224. Case #176.2 Large cell lymphoma 69 yr female with painful hip for 3 months
- 225. Cor CT scan Axial
- 226. Case #177 83 year female with lymphoma right pelvis
- 227. 6 months later with pathologic fracture
- 228. Another 6 mos later
- 229. Bone scan
- 230. Photomic
- 231. Case #178 40 year female lymphoma lower spine Sagittal T-2 MRI
- 232. Sagittal T-2 MRI upper spine
- 233. Sagittal T-2 MRI mid spine
- 234. Case #178.1 Lymphoma sacrum 72 year male with LBP for many years
- 235. Bone scan
- 236. Axial T-1 MRI T-2 Gad
- 237. T-1 T-2 Sagittal Gad STIR
- 238. Case #901 17 year male with lymphoma acetabulum
- 240. tumor Axial T-1 MRI
- 241. tumor Axial T-2 MRI
- 242. Photomic
- 244. Case #902 49 year male with lymphoma pelvis
- 245. tumor CT scan
- 246. Case #902.1 Lymphoma of pelvis 69 year male with 2 month history of left hip pain
- 247. tumor Coronal T-1 T-2 Gad C+
- 248. Sagittal T-1 T-2 Gad
- 249. Axial T-1 T-2 Gad
- 250. Case #903 44 year male with lymphoma pelvis
- 251. Case #904 31 year male with lymphoma pelvis
- 252. Bone scan
- 253. Case #905 40 year male lymphoma pelvis
- 254. Case #906 47 year male lymphoma distal femur
- 255. Lateral view
- 256. Bone scan 6 months later
- 257. Sagittal T-1 MRI
- 258. Sagittal T-1 MRI thru notch
- 260. tumor Axial T-2 MRI
- 261. Photomic
- 262. Case #906.5 49 year male with lymphoma distal femur
- 263. Lateral view
- 264. Bone scan
- 265. Sagittal T-1 MRI
- 266. Coronal T-1 MRI
- 268. Case # 906.6 Large cell lymphoma knee 48 year female with medial knee pain 1 year and history of torn medial meniscus & 18000 WBC & elevated cholesterol
- 269. Bone scan
- 270. Sag T-1 Cor T-2
- 271. Axial PD Femoral cut Tibial cut
- 272. Case #906.7 Lymphoma Bone scan 58 year male with painful swelling above knee for 3 months
- 273. Cor T-1 T-2 FS
- 274. Axial PD T-2
- 275. Sag PD T-2
- 276. Case #906.8 Lymphoma Path Fracture Distal Femur 55 yr female with recent severe knee pain & prior breast CA
- 277. Axial CT scan Bone scan
- 278. Cor T-1 T-2
- 279. Case #907 23 year female lymphoma distal femur
- 280. Lateral view
- 281. Bone scan
- 282. Sagittal T-1 MRI
- 283. Coronal T-1 MRI tumor
- 284. tumor tumor Coronal STIR MRI
- 285. Positive silver stain for reticulum fiber
- 286. Case #908 28 year male lymphoma femur
- 288. Photomic
- 289. Case #909 34 year male with lymphoma prox femur
- 290. Frog lateral
- 291. Case #910 38 year male pathologic fracture lymphoma prox femur
- 292. Case #911 Axial T-1 MRI tumor 77 year male with parosteal lymphoma femur
- 293. tumor Axial T-2 MRI
- 294. Case #912 17 year male lymphoma distal femur
- 295. AP view
- 296. Coronal T-1 MRI tumor
- 298. Case #913 Coronal T-1 MRI 54 year male with HIV lymphoma proximal femur
- 299. tumor Axial proton density MRI
- 300. Case #914 65 year female ORIF hip fracture prior history of lymphoma 5 yrs ago
- 301. 5 years later with OGS at healed fracture site
- 302. Bone scan shows multifocal OGS
- 303. Case #915 41 year male lymphoma proximal tibia
- 304. Lateral view
- 305. Oblique view 3 months later
- 306. Pathologic fracture following radiation therapy at 6 months
- 307. Photomic
- 308. Custom total knee prosthesis for reconstruction
- 309. Post op x-ray with prosthetic reconstruction
- 310. Case #916 34 year female lymphoma prox tibia
- 311. Sagittal T-1 MRI
- 312. Sagittal T-2 MRI
- 313. Case #917 21 year female with lymphoma proximal tibia
- 314. Coronal T-1 MRI
- 316. Case #918 26 year female lymphoma distal tibia
- 317. tumor Coronal T-1 MRI
- 318. Sagittal T-1 MRI tumor
- 319. tumor Axial T-2 MRI
- 320. Case #919 29 year female lymphoma proximal humerus
- 321. Bone scan
- 322. Coronal T-1 MRI
- 323. tumor Axial proton density MRI
- 324. Photomic
- 325. Case #920 Pathologic fracture lymphoma proximal humerus in a 64 year female
- 326. Bone scan
- 327. Coronal T-2 MRI tumor
- 328. Case #921 38 year female with lymphoma humerus
- 329. Bone scan
- 330. Coronal T-2 MRI
- 331. Case #922 27 year male lymphoma distal humerus
- 332. Sagittal T-1 MRI
- 333. tumor Axial T-2 MRI
- 334. Photomic
- 335. Case #923 28 year male with lymphoma proximal ulna
- 336. Axial T-1 MRI
- 337. Axial T-2 MRI tumor
- 338. Case #924 Laminogram x-ray 50 year female with lymphoma proximal ulna
- 339. Case #925 Sagittal T-1 MRI tumor tumor 64 year female with soft tissue lymphoma forearm
- 340. tumor Axial proton density MRI
- 341. Axial T-2 MRI
- 342. Case #926 70 year female with lymphoma distal radius
- 343. Case #927 Tumor defect 20 year male with lymphoma sacrum 1 year post resection and radiation therapy
- 344. 2.5 years post op
- 345. Case #928 43 year male with lymphoma 11th posterior rib
- 346. Resection specimen cut in path lab
- 347. Photomic
- 349. Case #929 pain 73 year female with radiation osteitis 2nd to radiation therapy for ovarian carcinoma 19 years ago
- 350. 9 days later with path fracture looking like lymphoma; biopsy negative for sarcoma
- 351. 2 weeks later with progressive collapse
- 352. 6 weeks later and more collapse
- 353. Coronal T-1 MRI with low signal like a lymphoma
- 354. Coronal proton density MRI
- 355. Case #929.1 Lymphoma pseudotumor transient osteoporosis 25 year male alcoholic and smoker with R hip pain 4 mos
- 356. Cor T-1 Cor T-2
- 357. Axial T1 Axial T-2
- 358. Case #930 52 year male radiation osteitis humerus 2nd to radiation for soft tissue sarcoma years ago now looking like a lymphoma
- 359. Pathologic fracture later requiring IM nail
- 360. Case #931 54 year male tennis player with stress fracture sacrum
- 361. R L Bone scan
- 362. CT scan showing fracture callus
- 363. pseudotumor Coronal T-1 MRI showing low signal like lymphoma
- 364. Coronal T-2 MRI showing high signal from fracture
- 365. Case #932 22 year male stress fracture thru lateral plateau looking like a lymphoma
- 366. Bone scan hot like lymphoma
- 367. Sagittal T-1 MRI showing fracture edema looking like lymphoma
- 368. Case #933 32 year female mastocytosis spine & pelvis looking like large cell lymphoma
- 369. Femoral mastocytosis looking like lymphoma
- 372. Changes in ribs & humerus
- 373. Hodgkin’s Lymphoma
- 374. CLASSIC Case #179 40 year male blastic form of Hodgkin’s lymphoma L-4
- 375. Photomic showing Reed-Sternberg cell
- 376. Case #180 33 year female with Hodgkin’s disease SI area
- 377. Photomic with Reed-Sternberg cells
- 378. Case #934 58 year male with blastic form Hodgkin’s lymphoma pelvis
- 379. Left iliac lesions
- 380. Right iliac lesion
- 381. Photomic with Reed-Sternberg cells & eosinophils
- 382. Case #935 38 year male with blastic form of lymphoma L-3
- 383. Case #936 51 year male lytic form of Hodgkin’s lymphoma L-4
- 384. eosinophil Photomic with Reed-Sternberg cell
- 385. Case #936.1 Hodgkin’s lymphoma 28 year old male with hip pain for past 3 months
- 386. Bone scan
- 387. Cor T-1 T-2 Gad
- 388. Axial T-1 T-2 gad
- 389. Case #936.2 Hodgkin’s of Scapula 25 yr male with pain in shoulder 1 year
- 390. Cor T-2 Gad
- 391. Axial T-2 Axial Gad Sag T-2 Sag Gad
- 392. Leukemia
- 393. CLASSIC Case #181 10 year female with hemorrhagic purpura second to acute lymphoblastic leukemia
- 394. Transverse radioleucent metaphyseal bands seen in acute lymphoblastic leukemia
- 395. Lymphoblasts in peripheral blood smear
- 396. Case #937 59 year male chronic lymphocytic leukemia Bone scan
- 397. Coronal T-1 MRI
- 398. Sagittal T-1 MRI
- 399. Coronal T-1 MRI
- 400. Coronal T-1 MRI
- 401. Coronal T-2 MRI
- 402. Lymphoblasts seen in marrow smears
- 403. Case #938 4.5 year male acute lymphoblastic leukemia
- 404. Bone scan
- 405. Axial T-2 MRI
- 406. Lymphoblasts in peripheral blood smeer
- 407. Case #939 40 year male 5 year history of chronic lymphocytic leukemia with chronic reactive periostitis
- 408. Lateral view
- 409. Case #940 14 month female with acute lymphoblastic leukemia femur showing laminated periostitis
- 410. Casswe #941 43 year male with tumor chronic granulocytic leukemia with focal lesion in femur
- 411. tumor Another view
- 412. Case #941.1 Acute lymphocytic leukemia 3/06 4/06 6/06 12 year female with wrist pain and elevated sed rate 3 mos
- 413. 6/06 Coronal T-1 T-2 Sagittal T-2
- 414. Case #942 4 year female acute lymphocytic leukemia with laminated periostitis fibula
- 415. Case #943 4 year male acute lymphocytic leukemia hand
- 416. Case #944 40 year female chronic lymphocytic leukemia with osteoporotic codfish shaped vertebral bodies
- 417. AP view
- 418. Plasma Cell Tumors
- 420. Solitatary Plasmacytoma To fit the strict criteria for the diagnosis of a solitary plasmacytoma, the patient should present with a single bony involvement, as demonstrated by a bone skeletal survey, and remain free of other bony site involvement for at least six months after the initial diagnosis. Unfortunately, in approximately 70% of cases, the solitary form of the disease will disseminate into the more common form of multiple myeloma. Likewise, in the case of pure solitary plasmacytoma, the serum protein electrophoresis study is completely normal in 75% of cases with the remaining 25% showing a mild abnormality. The age group for solitary plasma- cytoma is slightly younger than multiple myeloma, typically before the age of 40 years. The most common sites of involvement include the spine, pelvis and proximal femur with radiographic evidence of a solitary lytic destruction of bone that may take on the appearance of a benign lesion such as a solitary form of fibrous
- 421. dysplasia. Because the disease is purely lytic in nature, the bone isotope scan may be negative. Since the disease is considered localized at first, the treatment is localized with a wide surgical resection and prosthetic replacement, with or without bone cement, followed by local radiation therapy if the margins are positive. No systemic chemotherapy is used until the disease becomes more disseminated as demonstrated by increased levels of abnormal myeloma protein found by serum electrophoresis studies. The prognosis for survival is quite good until the disease becomes more disseminated which is usually within three years after the initial diagnosis.
- 422. CLASSIC Case #182 40 year male with solitary plasmacytoma pelvis
- 423. Bone scan showing signal void
- 424. Axial T-1 MRI
- 425. Axial T-2 MRI
- 426. Photomic showing plasma cells
- 427. High power
- 428. Case #183 42 year male with solitary plasmacytoma pelvis
- 429. Axial T-1 MRI
- 430. Axial T-2 MRI
- 431. Post op x-ray after radiation therapy & total hip replacement
- 432. Case #184 53 year male solitary plasmacytoma proximal femur
- 433. Pathologic fracture one year later
- 434. Post op x-ray with cemented long stem biopolar prosthesis
- 435. Case #185 55 year male solitary plasmacytoma proximal femur
- 436. Case #185.1 Solitary plasmacytoma 40 year male with increasing pain in thigh for 6 mos
- 437. Bone scan
- 438. Sag T-1 PD FS Cor STIR
- 439. Axial T-1 T-2 Gad
- 440. PO interlocking nail and cementation
- 441. Case #946 49 year male solitary plasmacytoma acetabulum
- 442. tumor CT scan
- 443. Bone scan
- 444. Photomic
- 445. Steinman pin Reconstruction with metal cage
- 446. Cementation over metal and completed THA inside cage
- 447. Post op X-ray
- 448. Case #947 tumor 32 year male with solitary plasmacytoma acetabulum
- 449. Coronal T-1 MRI
- 450. Case #948 53 year male with solitary plasmacytoma sacrum
- 451. R L Bone scan shows signal void in tumor
- 452. tumor CT scan
- 453. Sagittal T-2 MRI tumor
- 454. Case #949 52 year male with large solitary plasmacytoma pelvis
- 455. CT scan at sacral level
- 456. tumor CT scan at lumbar level
- 457. Case #950 45 year male with solitary plasmacytoma sacrum
- 458. Lateral view tumor
- 459. Bone scan shows signal void in tumor site
- 460. tumor Bone scan
- 461. tumor Axial T-2 MRI
- 462. Sagittal PD MRI tumor
- 463. Sagittal T-2 MRI tumor
- 464. Photomic
- 465. Case #951 Axial T-1 MRI tumor 56 year male with solitary plasmacytoma sacrum
- 466. Sagittal T-1 MRI tumor
- 467. Case #952 28 year female with path fracture thru supra acetabular Solitary plasmacytoma
- 468. Case #953 46 year male with solitary plasmacytoma proximal femur
- 469. Coronal T-1 MRI
- 470. Coronal T-2 MRI
- 471. Case #954 65 year female with solitary plasmacytoma femur
- 472. Post op x-ray with blade-plate fixation
- 473. Case #955 41 year male with solitary plasmacytoma femur
- 474. Case #956 40 year female with solitary plasmacytoma proximal fibula
- 475. Case #957 tumor 24 year male with solitary plasmacytoma scapula
- 476. Bone scan showing signal void in center of tumor
- 477. tumor CT scan
- 478. Multiple Myeloma
- 479. Multiple Myeloma Multiple myeloma is considered to be the most common primary tumor of bone, accounting for approximately 45% of all malignant bone tumors. It is usually seen in patients over 40 years of age and is two times more common in blacks than whites. Radiographically, the lytic lesions seen in multiple myeloma are typically punched-out with fairly sharp margins but no sclerotic response at the periphery and thus are not frequently picked up on a total body bone isotope study. The diagnosis is usually made by a combination of a bone marrow biopsy and a serum protein electrophoresis that reveals the elevated monoclonal immuninoglobulin at either the alpha or gamma spike. Bence-Jones protein is found in the urine examination secondary to a light chain immuninoglobulin spillover. Three per cent of patients with myeloma have a sclerotic form (seen on the radiographic examination) associated with a peripheral neuropathy. This type of multiple myeloma has a better prognosis
- 480. for survival and is referred to as the Poems syndrome. Skeletal lesions are more typically seen in the spine and pelvic area and proximal long bones, but rarely seen distal to the elbow or knee. In aggressive forms of myeloma with extensive bony destruction by osteoclastic erosion, the patients will develop hypercalcemia that can result in a semi-comatose state and sometimes is associated with nephrocalcinosis. Renal damage also results from excessive proteins plugging the renal tubules. Pathological fractures are common because of excessive osteoclastic activity (osteoclysis) that can be inhibited by drugs such as Aredia. Even though large concentrations of imminoglobulin are produced by the malignant plasma cells, the patient’s resistance to infection is markedly inhibited and surgical complications resulting from infection should be anticipated when operating on patients with this disease. Systemic chemotherapy has greatly improved the prognosis for survival in this disease. The drugs used include Malphalan and cortisone which have increased the chance for survival to three years.
- 481. Local treatment consists of external beam radiation therapy and intramedullary devices, such as long stem prostheses and inter- locking nails supplemented with bone cement, for pathological fractures. Excessive bleeding at the time of surgery is typical with myeloma patients, similar to the problem faced with patients with metastatic renal cell disease and thyroid carcinoma. It is important to radiate the entire long bone involved when considering intra- medullary device fixation because of the potential for newer lesions arising distal to the fixation device at a later date.
- 482. CLASSIC Case #186 fracture 65 year male with multiple myeloma pelvis and hips
- 483. Photomic showing plasma cells
- 484. R L Post op x-ray with THR right & ORIF left
- 485. Case #187 72 year male with multiple myeloma skull
- 487. Case #188 Sagittal T-2 MRI 55 year male with multiple myeloma spine
- 488. Sagittal T-2 MRI lumbar spine with evidence of cord compression
- 489. Case #958 37 year male with multiple myeloma dorsal spine
- 490. Lumbar spine
- 491. Autopsy specimens
- 492. Photomic
- 493. Case #959 55 year male with multiple myeloma dorsal spine
- 494. Lateral view
- 495. CT scan showing tumor in vertebra and vertebral canal
- 496. CT of adjacent vertebra
- 498. Photomic
- 499. Case #960 48 year male with multiple myeloma dorsal spine with cord involvement tumor Sagittal T-2 MRI
- 500. Axial T-2 MRI showing tumor in pedicle & costovertebral joint
- 501. tumor Another axial T-2 cut
- 502. Biopsy photomic
- 503. Case #961 55 year male with multiple myeloma cervical spine and compression fracture
- 504. Post op posterior spinal fusion and radiation therapy
- 505. Case #962 38 year male with multiple myeloma lumbar spine
- 506. Post op anterior curettement and cementation
- 507. AP view
- 508. Case #963 41 year male with multiple myeloma with collapsed vertebral body and paraplegia
- 509. Lateral view
- 510. Case #964 16 year male with multiple myeloma lumbar spine
- 511. Case #965 tumor 59 year female with multiple myeloma pelvis
- 512. tumor CT scan showing large aneuysmal lesion
- 513. tumor Another CT cut
- 514. Post op x-ray with THA with cement and Steinman pins
- 515. Skull x-ray showing multiple punched out lesions
- 516. Case #966 72 year female with severe multiple myeloma pelvis
- 517. Case #967 59 year female with multiple myeloma skull
- 518. Same patient with scapular and humeral lesions
- 519. Thumb lesion
- 520. Case #967.1 Multiple Myeloma 55 yr male with a painful swollen wrist for 6 months
- 522. Case #968 55 year female with multiple myeloma with path fracture femur
- 523. Post op x-ray with cemented long stem THA
- 524. Case #969 75 year male with multiple myeloma and path fracture femur
- 525. Case #970 68 year female with multiple myeloma shoulder area
- 526. Same patient with tibial lesions
- 528. Punched out humeral lesions as well
- 529. Path fracture later on with IM nail fixation
- 530. Photomic
- 531. Case #971 62 year male with multiple myeloma humerus
- 532. Post op cemented Neer prosthesis
- 533. Case #972 37 year male with multiple myeloma upper extremity with punched out lesions
- 534. Case #973 48 year female with multiple myeloma shoulder
- 535. Bone scan with scapular and rib lesions
- 536. Coronal T-1 MRI
- 537. tumor Axial T-2 MRI
- 538. Case #974 72 year male with multiple myeloma lumbar spine
- 539. Same patient with punched out lesions in femur and ischium
- 540. Also punched out lesions in tibia and fibula
- 541. Case #975 29 year male with blastic form of multiple myeloma
- 542. Close up
- 543. Case #976 40 year male with a variant of multiple myeloma known as fibrogenesis imperfecta ossium
- 544. Multiple collapsed lumbar vertebra as in multiple myeloma
- 545. X-ray at a later date with progressive disease
- 546. X-ray of pelvis shows diffuse lytic changes
- 547. Bone scan
- 549. Metastatic Neuroblastoma Neuroblastoma is a primitive tumor of childhood taking its origin from the medullary portion of the adrenal gland or in other parts of the sympathetic nervous system and is considered to be the third most common malignancy in childhood. This tumor is usually seen under the age of five years and typically metastasizes to bones including the vertebra, ribs, skull, femur, pelvis, humerus, tibia, and radius. These patients usually have systemic symptoms including weight loss, fever, generalized pain and anemia. Radiographically, the lesions in bone have a permeative destructive pattern typically in the metaphyseal portion of long bones. Histologically, the characteristic feature of the neuroblastoma is a rosette formation with neurofibrils. However, on routine H&E stains the histology is quite similar to that of rhabdomyosarcoma, non-Hodgkin’s lymphoma and Ewing’s sarcoma. Diagnostic studies include cytogenetics that will reveal a chromosomal abnormality in the
- 550. number 1 chromosome. A CT scan of the abdomen will frequently pick up a neoplastic abnormality in the kidneys. Chemotherapy and sometimes bone marrow transplantation is used in the treatment protocol for this aggressive, extensive metastatic disease but with only a a 20-25% chance for survival at five years after diagnosis.
- 551. CLASSIC Case #189 4 year male metastatic neuroblastoma distal femur with pathologic fracture
- 552. Lateral view showing hair-on-end reactive subperiosteal bone formation
- 553. Bone scan
- 554. Bone scan shows abnormal collection in kidney where the primary tumor was found
- 555. Sagittal T-2 MRI showing metastatic tumor in tibia
- 556. tumor Abdominal CT scan showing primary neuroblastoma in the kidney area
- 557. Chest x-ray showing multiple pulmonary mets
- 558. Femoral biopsy photomic showing rosette pattern
- 559. Higher power showing rosette pattern
- 560. Case #977 7 year male with metastatic neuroblastoma proximal humerus and path fracture
- 561. Bone scan showing primary tumor in kidney and met to shoulder & base of skull
- 562. Photomic from humeral biopsy
- 563. Case #978 9 year male with metastatic neuroblastoma proximal humerus
- 564. Another view
- 565. Case #979 1 year old female with metastatic neuroblastoma proximal humerus
- 566. Case #980 5 year female with metastatic neuroblastoma proximal femur
- 567. Case #981 11 year female with metastatic neuroblastoma femur treated with wide resection and fibular strut & IM nail reconstruction
- 568. Macro section from resected specimen showing tumor inside and outside the femur
- 571. Case #982 7 year male with metastatic neuroblastoma distal femur
- 572. Case #983 7 month male with large calcific renal mass which on biopsy proved to be neuroblastoma
- 573. Lateral view