MSK cases for discussion

Dr. Abdelaty Shawky Dr. Gehan Mohamed

Case 1

• A 9-year-old boy complains of 2 weeks of pain in

the hip. His temperature is 38.9°C. Laboratory

studies show an elevated erythrocyte

sedimentation rate. An X-ray reveals a mottled

radiolucent defect in the upper femur, with

abundant periosteal new bone formation.

• Fine-needle aspiration shows numerous

neutrophils and cocci. Staphylococcus aureus is

cultured from the bone lesion. A biopsy shows

a fragment of necrotic bone embedded in

fibrinopurulent exudate.

M/E

Dense neutrophilic infiltrate and necrotic bone

M/E

Inflammatory infiltrate surrounding a necrotic bone fragment

Now answer

• Your diagnosis of the case is….

• Most common site of affection is….. Why??

• Necrotic bone is called…….

• Subperiosteal new bone formation is called….

• And openings through which pus is discharged are

called…..

Case 2

• A 10-year-old boy complains of pain and swelling

around his right knee of 3 weeks' duration that

has not improved with rest. His mother denies a

history of trauma to the knee. A radiograph

shows a destructive mass arising from the

metaphysis of the distal femur

RADIOLOGY

• l • Plain radiograph• shows an ill-defined• destructive tumor in• the distal femur.• Sun ray appearance• Codman’s triangle

Grossly

• Irregular mass occupying the medullary part of metaphysis destroying the cortex.

• Grayish white, with areas of hemorrhage.

Microscopic examination

Malignant spindle-shaped cells laying down osteoid matrix

Now answer…

• Your diagnosis of the case is……

• Most common site and age of the tumor is……

• Spread of this tumor is by….. and prognosis is….

Case 3• A 65-year-old man complains of pain in his back,

fatigue• An X-ray examination reveals numerous lytic

lesions• in the lumbar vertebral bodies. Laboratory studies

disclose mild anemia, and thrombocytopenia.• Urinalysis shows 4+ proteinuria. A bone marrow

biopsy discloses foci of abnormal plasma cell proliferation.

Radiology, Gross

Multiple osteolytic lesions in the skull , vertebrae and

pelvic bones

M/E

Plasma cells with different grades of differentiation

Now

• What is your diagnosis of the case?.............