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Case Presentation: Femur Destruction ? Malignancy ? Osteomyelitis.

Case Presentation: Femur Destruction ? Malignancy ? Osteomyelitis. Pathology. Case details:. 39 Year Fijian Male Right hip hard large swelling, difficulty in walking Diffuse hard mass around Rt.thigh, tender,Local temp. raised, induration present.

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Case Presentation: Femur Destruction ? Malignancy ? Osteomyelitis.

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  1. Case Presentation:Femur Destruction? Malignancy ? Osteomyelitis. Pathology

  2. Case details: • 39 Year Fijian Male • Right hip hard large swelling, difficulty in walking • Diffuse hard mass around Rt.thigh, tender,Local temp. raised, induration present. • Radiography showed destruction of upper femur. • Had a normal pelvic xray 4 months before, done for pain in Rt. Hip & thigh-interpreted as “meralgia paraesthetica” at that time. • ? Sarcoma ? Osteomyelitis.

  3. Investigations: • INVESTIGATIONS ON 10/06/02 :- • Hb - 10.8 gm% • TC - 8,400 /cmm • ESR- 110 • Total Acid Phosphatase - 8.94 [ N 0 - 6.5 ] • Alkaline Phosphate - 210 [ N 39 - 117 ] • Sr. Albumin - 34.7 [ N 35 - 55 ] • Sr. Globulin - 51 [ N 15 - 30 ] • Bence Jones Protein - Negative • LFT’s - Within Normal Limits

  4. Normal X-Ray Hip - Feb. 2002 ?

  5. On Traction – June 2002 ?

  6. After Biopsy – June 2002 ?

  7. Femur Destruction - June 2002

  8. Histopathology of Tumor • Inflammatory granulation tissue • Foci of abscess

  9. Histopathology of Tumor • Inflammatory granulation tissue • Foci of abscess • Degenerating muscle

  10. Histopathology of Tumor • Inflammatory granulation tissue • Foci of abscess • Degenerating muscle

  11. Histopathology of Tumor • Inflammatory granulation tissue • Foci of abscess • Degenerating muscle

  12. Histopathology of Tumor • Focus of chronic Abscess with plenty of plasma cells.

  13. Histopathology of Tumor • Focus of chronic Abscess around blood vessel.

  14. Histopathology of Tumor • Areas of new bone formation – Callus formation.

  15. Histopathology of Tumor • Areas of new bone formation – Callus.

  16. Histopathology of Tumor • Inflammation around degenerating muscle

  17. Follow up X-Ray – July 2002

  18. SERUM ELECTROPHORESIS(at Suva Private Hospital) • TOTAL PROTEIN - 90 GM/L [65- 85] • ALBUMIN - 32 GM/L [38 -50] • alpha-1-GLOBULIN- 7 GM/L [3-7 ] • beta -1- GLOBULIN- 14 GM/L [5- 11] • BETA GLOBULIN - 8 GM/L [4- 11] • GAMMA GLOBULIN - 31 GM/L[6- 15] * Impression- Polyclonal hyper gamma globulinaemia. Pattern seen in patients with chronic inflammation [autoimmune disorders, chronic liver diseases etc.]

  19. Pathology Discussion: • Areas of abscess, necrosis, hemorrhage. • Large areas of granulation tissue • Areas of fibrosis, inflammation both acute and chronic • With focal abscess formation • Reactive new bone formation – Callus • Features suggest Inflammatory pathology suggestive of Osteomyelitis. • Microbiological studies, ? Fungus ? bacterial

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