Volume 8
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Transcript of Volume 8
![Page 1: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/1.jpg)
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
![Page 2: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/2.jpg)
Round Cell
Tumors Of Bone
![Page 3: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/3.jpg)
Ewing’s Sarcoma
![Page 4: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/4.jpg)
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
![Page 5: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/5.jpg)
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, rib, 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
![Page 6: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/6.jpg)
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
![Page 7: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/7.jpg)
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.
![Page 8: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/8.jpg)
CLASSIC
Case #169
13 year female
Ewing’s sarcoma
distal femur
onion skin
periostitis
![Page 9: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/9.jpg)
Bone scan
![Page 10: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/10.jpg)
Coronal proton
density MRI
![Page 11: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/11.jpg)
Coronal T-2 MRI
![Page 12: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/12.jpg)
Coronal T-2 MRI
showing multifocal
disease
![Page 13: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/13.jpg)
Macro section Ewing’s
sarcoma distal femur
necrotic
viable
![Page 14: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/14.jpg)
Photomic showing pseudo-rosette formations
![Page 15: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/15.jpg)
Same patient with
multifocal involvement
proximal humerus
![Page 16: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/16.jpg)
Case #170
15 year female
Ewing’s sarcoma
proximal tibia
![Page 17: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/17.jpg)
Lateral view
![Page 18: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/18.jpg)
Sagittal T-1 MRI
![Page 19: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/19.jpg)
Axial T-1 MRI
![Page 20: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/20.jpg)
Photo of resected proximal tibia & prosthesis
Compress
system
![Page 21: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/21.jpg)
Placement of rotating
hinge Compress prosthesis
![Page 22: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/22.jpg)
Attachment of
patellar ligament with
double tooth washers
![Page 23: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/23.jpg)
X-ray 2 mos post op
anchor plug
![Page 24: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/24.jpg)
5.5 years post op
with excellent
osseointegration at
bone-prosthetic
interface
![Page 25: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/25.jpg)
11 years post op
![Page 26: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/26.jpg)
Case #171
19 year female
Ewing’ sarcoma
proximal femur
![Page 27: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/27.jpg)
Bone scan
![Page 28: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/28.jpg)
1 year later with
path fracture thru
radiated bone
![Page 29: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/29.jpg)
Persistent non union
after IM nailing
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X-ray 1 year post op
placement of cemented
long stem custom
bipolar prosthesis
![Page 31: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/31.jpg)
Case #172
13 year male with
“hair-on-end”reactive
subperiosteal new
bone formation
permeative
lysis
![Page 32: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/32.jpg)
Macro section resected
proximal femur
![Page 33: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/33.jpg)
Closeup macro section
showing “hair-on-end”
reactive subperiosteal
new bone
necrosis
periostium
permeation
![Page 34: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/34.jpg)
Closeup macro section
“hair-on-end” subperiosteal
reactive bone formation
periostium
![Page 35: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/35.jpg)
Photomic Ewing’s sarcoma
![Page 36: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/36.jpg)
Case #173
15 year male Ewing’s
sarcoma femur
hair-on-end
onion skin
![Page 37: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/37.jpg)
Case #174
28 year male with Ewing’s sarcoma pelvis
![Page 38: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/38.jpg)
CT scan
tumor
![Page 39: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/39.jpg)
Case #175
14 year male with Ewing’s sarcoma pelvis
![Page 40: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/40.jpg)
Macro section from
autopsy specimen
acetabulum
ilium
tumor
![Page 41: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/41.jpg)
Photomic
![Page 42: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/42.jpg)
Case #861
34 year female with Ewing’s sarcoma pelvis
![Page 43: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/43.jpg)
Close up hip
![Page 44: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/44.jpg)
Coronal Gad contrast MRI
![Page 45: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/45.jpg)
Coronal T-2 MRI
![Page 46: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/46.jpg)
Axial T-1 MRI
![Page 47: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/47.jpg)
Axial proton density MRI
![Page 48: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/48.jpg)
Photomic
![Page 49: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/49.jpg)
Case #862
28 year male with Ewing’s sarcoma pubis
tumor
Coronal T-1 MRI
![Page 50: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/50.jpg)
Coronal T-2 MRI
tumor
![Page 51: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/51.jpg)
T-2 MRI
tumor
![Page 52: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/52.jpg)
Coronal T-2 MRI
tumor
![Page 53: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/53.jpg)
Axial PD MRI
tumor
![Page 54: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/54.jpg)
Photomic
![Page 55: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/55.jpg)
Axial PD MRI following successful chemotherapy
![Page 56: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/56.jpg)
Coronal T-2 MRI post chemo
![Page 57: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/57.jpg)
Case #863
10 year female with Ewing’s sarcoma pelvis
![Page 58: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/58.jpg)
6 months later
![Page 59: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/59.jpg)
Coronal T-1 MRI
![Page 60: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/60.jpg)
Coronal T-2 MRI
![Page 61: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/61.jpg)
Case #864
19 year male with Ewing’s sarcoma SI area
![Page 62: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/62.jpg)
Axial gad contrast MRI
![Page 63: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/63.jpg)
Axial T-2 MRI
![Page 64: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/64.jpg)
Photomic
![Page 65: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/65.jpg)
Post op cementation
![Page 66: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/66.jpg)
Case #865
19 year male
Ewing’s sarcoma
sacrum
![Page 67: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/67.jpg)
Close up
![Page 68: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/68.jpg)
Myelogram showing
nerve root pressure
![Page 69: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/69.jpg)
CT scan
tumor
![Page 70: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/70.jpg)
Photomic
![Page 71: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/71.jpg)
Case #866
12 year male
Ewing’s sarcoma
L-5
![Page 72: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/72.jpg)
Oblique view
![Page 73: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/73.jpg)
Case #867
37 year male
Ewing’s sarcoma
proximal femur
![Page 74: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/74.jpg)
Coronal T-1 MRI
![Page 75: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/75.jpg)
Photomic
![Page 76: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/76.jpg)
X-ray allograft
prior to implantation
AP lateral
![Page 77: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/77.jpg)
Post op alloprosthetic
reconstruction
![Page 78: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/78.jpg)
Case #868
14 year male
Ewing’s sarcoma
mid femur
Bone scan
![Page 79: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/79.jpg)
Pre chemo
Coronal proton
density MRI
![Page 80: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/80.jpg)
Axial PD MRI pre chemo
![Page 81: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/81.jpg)
Photomic
![Page 82: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/82.jpg)
Axial PD MRI post chemo
![Page 83: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/83.jpg)
Amputation following good chemo response
![Page 84: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/84.jpg)
Post op x-ray with modified bipolar reconstruction
cement
![Page 85: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/85.jpg)
Case #869
21 year male with Ewing’s sarcoma pelvis and femur
![Page 86: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/86.jpg)
Coronal T-1 MRI
![Page 87: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/87.jpg)
Coronal T-2 MRI
tumor
![Page 88: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/88.jpg)
Coronal T-2 MRI
![Page 89: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/89.jpg)
Case #870
7 year male
Ewing’s sarcoma
distal femur
![Page 90: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/90.jpg)
Bone scan
![Page 91: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/91.jpg)
Sagittal proton
density MRI
![Page 92: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/92.jpg)
Axial T-1 MRI
tumor
![Page 93: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/93.jpg)
Photomic
![Page 94: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/94.jpg)
Axial T-2 MRI post chemo
![Page 95: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/95.jpg)
Coronal T-2 MRI post chemo
![Page 96: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/96.jpg)
Case #871
13 year male
Ewing’s sarcoma
femur
![Page 97: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/97.jpg)
5 years after
radiation & chemo
with recurrence &
path fracture
![Page 98: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/98.jpg)
Post op x-ray with
IM nail for path
fracture
![Page 99: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/99.jpg)
Total femur replacement specimen
tumor bulge
![Page 100: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/100.jpg)
Custom total femur replacement prosthesis
![Page 101: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/101.jpg)
Placement of custom prosthesis
![Page 102: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/102.jpg)
Post op X-ray
![Page 103: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/103.jpg)
Case #872
16 year male
Ewing’s sarcoma
proximal femur
![Page 104: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/104.jpg)
Lateral view
![Page 105: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/105.jpg)
Coronal T-1 MRI
![Page 106: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/106.jpg)
Coronal T-2 MRI
![Page 107: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/107.jpg)
Axial proton density MRI
![Page 108: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/108.jpg)
Case #873
9 year male with Ewing’s sarcoma tibia
![Page 109: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/109.jpg)
Bone scan
![Page 110: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/110.jpg)
Sagittal T-1 MRI T-2 MRI
![Page 111: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/111.jpg)
Post op reconstruction
allograft over IM nail
![Page 112: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/112.jpg)
8 years later
![Page 113: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/113.jpg)
Case #875
2.5 year male
Ewing’s sarcoma
distal tibia
onion skin laminated periostitis
![Page 114: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/114.jpg)
Lateral view entire tibia
![Page 115: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/115.jpg)
Coronal T-1 MRI
![Page 116: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/116.jpg)
Axial T-1 Gad contrast MRI
![Page 117: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/117.jpg)
Case #876
17 year male with
Ewing’s sarcoma tibia
![Page 118: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/118.jpg)
Different view
![Page 119: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/119.jpg)
Post op allographic
reconstruction allograft
![Page 120: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/120.jpg)
Multifocal lesion prox
femur 6 mos later
![Page 121: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/121.jpg)
Case #877
19 year female with
Ewing’s sarcoma
proximal humerus
tumor
hair on
end
![Page 122: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/122.jpg)
Post op alloprosthetic
reconstruction
![Page 123: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/123.jpg)
Case #878
39 year male
Ewing’s sarcoma
proximal humerus
![Page 124: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/124.jpg)
X-ray one year later
without treatment
![Page 125: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/125.jpg)
Photomic
![Page 126: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/126.jpg)
Case #879
10 year male with Ewing’s sarcoma scapula
![Page 127: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/127.jpg)
Scapular view
![Page 128: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/128.jpg)
Bone scan
![Page 129: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/129.jpg)
CT scan
![Page 130: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/130.jpg)
Special CT scan scapula
![Page 131: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/131.jpg)
Case #880
9 year male with Ewing’s sarcoma scapula
![Page 132: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/132.jpg)
Case #881
20 year male with Ewing’s of scapula
![Page 133: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/133.jpg)
Special soft tissue technique x-ray
Soft tumor
![Page 134: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/134.jpg)
Case #882
16 year male with Ewing’s sarcoma clavicle
![Page 135: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/135.jpg)
Case #883
16 year female with Ewing’s sarcoma clavicle
![Page 136: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/136.jpg)
Case #884
7 year female with Ewing’s sarcoma 3rd posterior rib
![Page 137: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/137.jpg)
Case #885
17 year female with Ewing’s sarcoma post 7th rib
![Page 138: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/138.jpg)
Case #886
11 year male with Ewing’s sarcoma rib
![Page 139: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/139.jpg)
Case #887
12 year female
Ewing’s sarcoma
fibula
![Page 140: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/140.jpg)
Macro section from
resected specimen
![Page 141: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/141.jpg)
Scanning lens
photomic
![Page 142: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/142.jpg)
Higher power
![Page 143: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/143.jpg)
Case #888
20 year female
Ewing’s sarcoma
distal fibula
![Page 144: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/144.jpg)
Axial T-2 MRI
tumor
![Page 145: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/145.jpg)
Case #889
15 year female
Ewing’s sarcoma
proximal fibula
![Page 146: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/146.jpg)
Case #890
18 year male
Ewing’s sarcoma
distal fibula
![Page 147: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/147.jpg)
Bone scan
![Page 148: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/148.jpg)
Case #891
17 year male with Ewing’s sarcoma 4th metatarsal
![Page 149: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/149.jpg)
Coronal T-1 MRI
![Page 150: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/150.jpg)
Axial T-1 MRI
tumor
![Page 151: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/151.jpg)
Axial T-2 MRI
tumor
![Page 152: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/152.jpg)
Photomic with pseudo-rosettes
![Page 153: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/153.jpg)
CT scan thoracic spine shows multi focal lesion
![Page 154: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/154.jpg)
Coronal CT scan
![Page 155: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/155.jpg)
Case #892
35 year female with Ewing’s sarcoma os calcis
![Page 156: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/156.jpg)
Several months later
tumor
![Page 157: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/157.jpg)
T-1 MRI
tumor
![Page 158: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/158.jpg)
Gad contrast MRI
tumor
![Page 159: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/159.jpg)
Case #893
21 year male
Ewing’s sarcoma
mid tarsal area
![Page 160: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/160.jpg)
Case #894
20 year male
Ewing’s sarcoma
2nd toe
![Page 161: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/161.jpg)
Case #895
5 year female
Ewing’s sarcoma
proximal ulna
![Page 162: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/162.jpg)
Lateral view
![Page 163: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/163.jpg)
Axial T-1 MRI
![Page 164: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/164.jpg)
Sagittal T-1 MRI
![Page 165: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/165.jpg)
Coronal T-2 MRI
![Page 166: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/166.jpg)
Photomic
![Page 167: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/167.jpg)
Case #896
50 year female with Ewing’s sarcoma proximal ulna
![Page 168: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/168.jpg)
Case #897
2 year old Ewing’s
sarcoma middle finger
![Page 169: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/169.jpg)
Lateral view
![Page 170: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/170.jpg)
Sagittal T-1 MRI
![Page 171: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/171.jpg)
Photomic
![Page 172: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/172.jpg)
Case #898
15 year male with Ewing’s sarcoma thumb
![Page 173: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/173.jpg)
Case #898.1
18 year male with lateral knee knee for 3 months
Parosteal Ewing’s sarcoma
![Page 174: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/174.jpg)
Bone scan
![Page 175: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/175.jpg)
Axial T-1 Axial Gad C+
![Page 176: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/176.jpg)
Coronal STIR Gad C+ Sagittal Gad C+
![Page 177: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/177.jpg)
Case #898.2
13 year male with painful mass in forearm for 3 months
Parosteal Ewing’s sarcoma
![Page 178: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/178.jpg)
Bone scan
![Page 179: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/179.jpg)
Cor T-1 T-2 FS
![Page 180: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/180.jpg)
Sag T-1 Gad
![Page 181: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/181.jpg)
Axial T-2 Gad
Post chemo T-2 Gad
![Page 182: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/182.jpg)
Ewing’s Sarcoma
Pseudotumors
![Page 183: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/183.jpg)
Case #899
11 year female
osteomyelitis distal femur
looking like Ewing’s
sarcoma
onion skin
periostitis
sclerosis
![Page 184: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/184.jpg)
Lateral view
![Page 185: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/185.jpg)
Bone scan
![Page 186: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/186.jpg)
Coronal T-2 MRI
![Page 187: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/187.jpg)
Axial T-2 MRI
![Page 188: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/188.jpg)
Photomic of reactive periostitis
![Page 189: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/189.jpg)
Photomic showing inflammatory cells
polys
lymphs
![Page 190: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/190.jpg)
Case #899.1
3/06 7/07 7/07
14 year old male with pain right arm for 17 months
Osteomyelitis Ewing’s pseudotumor
![Page 191: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/191.jpg)
Cor T-1 T-2 Gad
![Page 192: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/192.jpg)
Axial T-1 T-2 Gad
![Page 193: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/193.jpg)
Case #900
8 year male with acute
fracture thru prior
femoral stress fracture
Day of fracture
stress
periostitis
![Page 194: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/194.jpg)
3 days after acute fracture
Stress
periostitis
![Page 195: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/195.jpg)
At 3 weeks looking
like Ewing’s sarcoma
![Page 196: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/196.jpg)
6 mos later with solid
union unlike Ewing’s
sarcoma
![Page 197: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/197.jpg)
Case #900.5
Eosinophillic granuloma
fibula looking like
Ewing’s sarcoma in a
5 year male
![Page 198: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/198.jpg)
Lymphoma of
Bone
![Page 199: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/199.jpg)
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
![Page 200: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/200.jpg)
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
![Page 201: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/201.jpg)
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.
![Page 202: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/202.jpg)
CLASSIC
Case #176
45 year male
lymphoma proximal
femur
path fracture
![Page 203: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/203.jpg)
Frog leg lateral
![Page 204: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/204.jpg)
Bone scan
signal void
![Page 205: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/205.jpg)
Coronal T-1 MRI
tumor
![Page 206: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/206.jpg)
Coronal T-2 MRI
tumor
![Page 207: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/207.jpg)
Axial T-2 MRI
![Page 208: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/208.jpg)
High power photomic showing folded nuclear forms
![Page 209: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/209.jpg)
Case #176.1
47 yr old male smoker with 4 mo history of left hip pain
Large cell lymphoma
![Page 210: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/210.jpg)
Bone scan
![Page 211: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/211.jpg)
Coronal
T-1 T-2
![Page 212: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/212.jpg)
Axial
T-1 T-2
![Page 213: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/213.jpg)
Post op IM nailing
![Page 214: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/214.jpg)
Case #177
83 year female with lymphoma right pelvis
![Page 215: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/215.jpg)
6 months later with pathologic fracture
![Page 216: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/216.jpg)
Another 6 mos later
![Page 217: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/217.jpg)
Bone scan
![Page 218: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/218.jpg)
Photomic
![Page 219: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/219.jpg)
Case #178
40 year female
lymphoma lower
spine
Sagittal T-2 MRI
![Page 220: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/220.jpg)
Sagittal T-2 MRI
upper spine
![Page 221: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/221.jpg)
Sagittal T-2 MRI
mid spine
![Page 222: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/222.jpg)
Case #178.1
72 year male with LBP for many years
Lymphoma sacrum
![Page 223: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/223.jpg)
Bone scan
![Page 224: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/224.jpg)
Axial T-1 MRI
T-2 Gad
![Page 225: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/225.jpg)
Sagittal
T-1
T-2
STIR
Gad
![Page 226: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/226.jpg)
Case #901
17 year male with lymphoma acetabulum
![Page 227: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/227.jpg)
Coronal T-1 MRI
tumor
![Page 228: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/228.jpg)
Axial T-1 MRI
tumor
![Page 229: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/229.jpg)
Axial T-2 MRI
tumor
![Page 230: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/230.jpg)
Photomic
![Page 231: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/231.jpg)
Good response from
chemotherapy
![Page 232: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/232.jpg)
Case #902
49 year male with lymphoma pelvis
![Page 233: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/233.jpg)
CT scan
tumor
![Page 234: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/234.jpg)
Case #902.1
69 year male with 2 month history of left hip pain
Lymphoma of pelvis
![Page 235: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/235.jpg)
Coronal T-1 T-2 Gad C+
tumor
![Page 236: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/236.jpg)
Sagittal T-1 T-2 Gad
![Page 237: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/237.jpg)
Axial
T-1
T-2
Gad
![Page 238: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/238.jpg)
Case #903
44 year male with
lymphoma pelvis
![Page 239: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/239.jpg)
Case #904
31 year male with lymphoma pelvis
![Page 240: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/240.jpg)
Bone scan
![Page 241: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/241.jpg)
Case #905
40 year male
lymphoma pelvis
![Page 242: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/242.jpg)
Case #906
47 year male
lymphoma
distal femur
![Page 243: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/243.jpg)
Lateral view
![Page 244: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/244.jpg)
Bone scan
6 months later
![Page 245: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/245.jpg)
6 months later
![Page 246: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/246.jpg)
Sagittal T-1 MRI
![Page 247: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/247.jpg)
Sagittal T-1 MRI thru notch
![Page 248: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/248.jpg)
Sagittal T-2 MRI
tumor
![Page 249: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/249.jpg)
Axial T-2 MRI
tumor
![Page 250: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/250.jpg)
Photomic
![Page 251: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/251.jpg)
Case #906.5
49 year male with lymphoma distal femur
![Page 252: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/252.jpg)
Lateral view
![Page 253: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/253.jpg)
Bone scan
![Page 254: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/254.jpg)
Sagittal T-1 MRI
![Page 255: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/255.jpg)
Coronal T-1 MRI
![Page 256: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/256.jpg)
Coronal STIR MRI
tumor
![Page 257: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/257.jpg)
Case # 906.6
48 year female with medial knee pain 1 year and history of
torn medial meniscus & 18000 WBC & elevated cholesterol
Large cell lymphoma knee
![Page 258: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/258.jpg)
Bone scan
![Page 259: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/259.jpg)
Sag T-1 Cor T-2
![Page 260: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/260.jpg)
Axial PD
Femoral cut Tibial cut
![Page 261: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/261.jpg)
Case #906.7 Bone scan
58 year male with painful swelling above knee for 3 months
Lymphoma
![Page 262: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/262.jpg)
Cor T-1 T-2 FS
![Page 263: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/263.jpg)
Axial PD T-2
![Page 264: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/264.jpg)
Sag PD T-2
![Page 265: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/265.jpg)
Case #907
23 year female
lymphoma
distal femur
![Page 266: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/266.jpg)
Lateral view
![Page 267: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/267.jpg)
Bone scan
![Page 268: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/268.jpg)
Sagittal T-1 MRI
![Page 269: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/269.jpg)
Coronal T-1 MRI tumor
![Page 270: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/270.jpg)
Coronal STIR MRI
tumor
tumor
![Page 271: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/271.jpg)
Positive silver stain for reticulum fiber
![Page 272: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/272.jpg)
Case #908
28 year male
lymphoma femur
![Page 273: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/273.jpg)
Macro section
resected specimen
![Page 274: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/274.jpg)
Photomic
![Page 275: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/275.jpg)
Case #909
34 year male with
lymphoma prox femur
![Page 276: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/276.jpg)
Frog lateral
![Page 277: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/277.jpg)
Case #910
38 year male
pathologic fracture
lymphoma prox femur
![Page 278: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/278.jpg)
Case #911
77 year male with parosteal lymphoma femur
tumor
Axial T-1 MRI
![Page 279: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/279.jpg)
Axial T-2 MRI
tumor
![Page 280: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/280.jpg)
Case #912
17 year male
lymphoma distal
femur
![Page 281: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/281.jpg)
AP view
![Page 282: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/282.jpg)
Coronal T-1 MRI
tumor
![Page 283: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/283.jpg)
Sagittal T-1 MRI
tumor
![Page 284: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/284.jpg)
Case #913
54 year male with HIV lymphoma proximal femur
Coronal T-1 MRI
![Page 285: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/285.jpg)
Axial proton density MRI
tumor
![Page 286: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/286.jpg)
Case #914
65 year female
ORIF hip fracture
prior history of
lymphoma 5 yrs ago
![Page 287: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/287.jpg)
5 years later with
OGS at healed
fracture site
![Page 288: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/288.jpg)
Bone scan shows multifocal OGS
![Page 289: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/289.jpg)
Case #915
41 year male
lymphoma
proximal tibia
![Page 290: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/290.jpg)
Lateral view
![Page 291: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/291.jpg)
Oblique view
3 months later
![Page 292: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/292.jpg)
Pathologic fracture
following radiation
therapy at 6 months
![Page 293: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/293.jpg)
Photomic
![Page 294: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/294.jpg)
Custom total knee
prosthesis for
reconstruction
![Page 295: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/295.jpg)
Post op x-ray with
prosthetic reconstruction
![Page 296: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/296.jpg)
Case #916
34 year female
lymphoma prox tibia
![Page 297: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/297.jpg)
Sagittal T-1 MRI
![Page 298: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/298.jpg)
Sagittal T-2 MRI
![Page 299: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/299.jpg)
Case #917
21 year female with lymphoma proximal tibia
![Page 300: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/300.jpg)
Coronal T-1 MRI
![Page 301: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/301.jpg)
Sagittal T-1 MRI
tumor
![Page 302: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/302.jpg)
Case #918
26 year female
lymphoma distal
tibia
![Page 303: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/303.jpg)
Coronal T-1 MRI
tumor
![Page 304: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/304.jpg)
Sagittal T-1 MRI
tumor
![Page 305: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/305.jpg)
Axial T-2 MRI
tumor
![Page 306: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/306.jpg)
Case #919
29 year female
lymphoma proximal
humerus
![Page 307: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/307.jpg)
Bone scan
![Page 308: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/308.jpg)
Coronal T-1 MRI
![Page 309: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/309.jpg)
Axial proton density MRI
tumor
![Page 310: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/310.jpg)
Photomic
![Page 311: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/311.jpg)
Case #920
Pathologic fracture
lymphoma proximal
humerus in a 64 year
female
![Page 312: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/312.jpg)
Bone scan
![Page 313: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/313.jpg)
Coronal T-2 MRI tumor
![Page 314: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/314.jpg)
Case #921
38 year female with
lymphoma humerus
![Page 315: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/315.jpg)
Bone scan
![Page 316: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/316.jpg)
Coronal T-2 MRI
![Page 317: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/317.jpg)
Case #922
27 year male
lymphoma distal
humerus
![Page 318: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/318.jpg)
Sagittal T-1 MRI
![Page 319: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/319.jpg)
Axial T-2 MRI
tumor
![Page 320: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/320.jpg)
Photomic
![Page 321: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/321.jpg)
Case #923
28 year male with lymphoma proximal ulna
![Page 322: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/322.jpg)
Axial T-1 MRI
![Page 323: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/323.jpg)
Axial T-2 MRI
tumor
![Page 324: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/324.jpg)
Case #924 Laminogram x-ray
50 year female with lymphoma proximal ulna
![Page 325: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/325.jpg)
Case #925
64 year female with soft tissue lymphoma forearm
Sagittal T-1 MRI
tumor tumor
![Page 326: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/326.jpg)
Axial proton density MRI
tumor
![Page 327: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/327.jpg)
Axial T-2 MRI
![Page 328: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/328.jpg)
Case #926
70 year female with
lymphoma distal radius
![Page 329: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/329.jpg)
Case #927
Tumor defect
20 year male with lymphoma sacrum
1 year post resection and radiation therapy
![Page 330: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/330.jpg)
2.5 years post op
![Page 331: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/331.jpg)
Case #928
43 year male with lymphoma 11th posterior rib
![Page 332: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/332.jpg)
Resection specimen cut in path lab
![Page 333: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/333.jpg)
Photomic
![Page 334: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/334.jpg)
Lymphoma
Pseudotumors
![Page 335: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/335.jpg)
Case #929
73 year female with radiation osteitis 2nd to radiation
therapy for ovarian carcinoma 19 years ago
pain
![Page 336: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/336.jpg)
9 days later with path fracture looking like lymphoma biopsy negative for sarcoma
![Page 337: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/337.jpg)
2 weeks later with progressive collapse
![Page 338: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/338.jpg)
6 weeks later and more collapse
![Page 339: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/339.jpg)
Coronal T-1 MRI with low signal like a lymphoma
![Page 340: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/340.jpg)
Coronal proton density MRI
![Page 341: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/341.jpg)
25 year male alcoholic and smoker with R hip pain 4 mos
Case #929.1 Lymphoma pseudotumor
![Page 342: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/342.jpg)
Cor T-1
Cor T-2
![Page 343: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/343.jpg)
Axial T1
Axial T-2
![Page 344: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/344.jpg)
Case #930
52 year male
radiation osteitis
humerus 2nd to
radiation for soft
tissue sarcoma
years ago now looking
like a lymphoma
![Page 345: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/345.jpg)
Pathologic fracture
later requiring
IM nail
![Page 346: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/346.jpg)
Case #931
54 year male tennis player with stress fracture sacrum
![Page 347: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/347.jpg)
R L
Bone scan
![Page 348: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/348.jpg)
CT scan showing fracture callus
![Page 349: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/349.jpg)
Coronal T-1 MRI showing low signal like lymphoma
pseudotumor
![Page 350: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/350.jpg)
Coronal T-2 MRI showing high signal from fracture
![Page 351: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/351.jpg)
Case #932
22 year male
stress fracture thru
lateral plateau looking
like a lymphoma
![Page 352: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/352.jpg)
Bone scan hot like lymphoma
![Page 353: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/353.jpg)
Sagittal T-1 MRI
showing fracture
edema looking
like lymphoma
![Page 354: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/354.jpg)
Case #933
32 year female
mastocytosis spine &
pelvis looking like
large cell lymphoma
![Page 355: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/355.jpg)
Femoral mastocytosis
looking like lymphoma
![Page 356: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/356.jpg)
Similar lesions
distal femur
![Page 357: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/357.jpg)
Same changes
in humerus
![Page 358: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/358.jpg)
Changes in ribs &
humerus
![Page 359: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/359.jpg)
Hodgkin’s
Lymphoma
![Page 360: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/360.jpg)
CLASSIC
Case #179
40 year male
blastic form of
Hodgkin’s lymphoma
L-4
![Page 361: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/361.jpg)
Photomic showing Reed-Sternberg cell
![Page 362: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/362.jpg)
Case #180
33 year female with Hodgkin’s disease SI area
![Page 363: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/363.jpg)
Photomic with Reed-Sternberg cells
![Page 364: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/364.jpg)
Case #934
58 year male with blastic form Hodgkin’s lymphoma pelvis
![Page 365: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/365.jpg)
Left iliac lesions
![Page 366: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/366.jpg)
Right iliac lesion
![Page 367: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/367.jpg)
Photomic with Reed-Sternberg cells & eosinophils
![Page 368: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/368.jpg)
Case #935
38 year male with
blastic form of lymphoma
L-3
![Page 369: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/369.jpg)
Case #936
51 year male
lytic form of
Hodgkin’s lymphoma
L-4
![Page 370: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/370.jpg)
Photomic with Reed-Sternberg cell
eosinophil
![Page 371: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/371.jpg)
Case #936.1
28 year old male with hip pain for past 3 months
Hodgkin’s lymphoma
![Page 372: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/372.jpg)
Bone scan
![Page 373: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/373.jpg)
Cor T-1 T-2 Gad
![Page 374: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/374.jpg)
Axial T-1 T-2
gad
![Page 375: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/375.jpg)
Leukemia
![Page 376: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/376.jpg)
CLASSIC Case #181
10 year female with hemorrhagic purpura second to
acute lymphoblastic leukemia
![Page 377: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/377.jpg)
Transverse radioleucent metaphyseal bands seen in
acute lymphoblastic leukemia
![Page 378: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/378.jpg)
Lymphoblasts in peripheral blood smear
![Page 379: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/379.jpg)
Case #937
59 year male
chronic lymphocytic
leukemia
Bone scan
![Page 380: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/380.jpg)
Coronal T-1 MRI
![Page 381: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/381.jpg)
Sagittal T-1 MRI
![Page 382: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/382.jpg)
Coronal T-1 MRI
![Page 383: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/383.jpg)
Coronal T-1 MRI
![Page 384: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/384.jpg)
Coronal T-2 MRI
![Page 385: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/385.jpg)
Lymphoblasts seen in marrow smears
![Page 386: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/386.jpg)
4.5 year male
acute lymphoblastic
leukemia
Case #938
![Page 387: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/387.jpg)
Bone scan
![Page 388: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/388.jpg)
Axial T-2 MRI
![Page 389: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/389.jpg)
Lymphoblasts in peripheral blood smeer
![Page 390: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/390.jpg)
Case #939
40 year male
5 year history of
chronic lymphocytic
leukemia with chronic
reactive periostitis
![Page 391: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/391.jpg)
Lateral view
![Page 392: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/392.jpg)
Case #940
14 month female with
acute lymphoblastic
leukemia femur showing
laminated periostitis
![Page 393: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/393.jpg)
Casswe #941
43 year male with
chronic granulocytic
leukemia with focal
lesion in femur
tumor
![Page 394: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/394.jpg)
Another view
tumor
![Page 395: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/395.jpg)
Case #941.1
3/06 4/06 6/06
12 year female with wrist pain and elevated sed rate 3 mos
Acute lymphocytic leukemia
![Page 396: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/396.jpg)
Coronal T-1 T-2 Sagittal T-2
6/06
![Page 397: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/397.jpg)
Case #942
4 year female
acute lymphocytic
leukemia with
laminated periostitis
fibula
![Page 398: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/398.jpg)
Case #943
4 year male
acute lymphoblastic
leukemia hand
![Page 399: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/399.jpg)
Case #944
40 year female
chronic monocytic
leukemia with
osteoporotic codfish
shaped vertebral bodies
![Page 400: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/400.jpg)
AP view
![Page 401: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/401.jpg)
Plasma Cell
Tumors
![Page 402: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/402.jpg)
Solitary
Plasmacytoma
![Page 403: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/403.jpg)
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
![Page 404: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/404.jpg)
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.
![Page 405: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/405.jpg)
CLASSIC Case #182
40 year male with solitary plasmacytoma pelvis
![Page 406: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/406.jpg)
Bone scan showing
signal void
![Page 407: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/407.jpg)
Axial T-1 MRI
![Page 408: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/408.jpg)
Axial T-2 MRI
![Page 409: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/409.jpg)
Photomic showing plasma cells
![Page 410: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/410.jpg)
High power
![Page 411: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/411.jpg)
Case #183
42 year male with solitary plasmacytoma pelvis
![Page 412: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/412.jpg)
Axial T-1 MRI
![Page 413: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/413.jpg)
Axial T-2 MRI
![Page 414: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/414.jpg)
Post op x-ray after
radiation therapy &
total hip replacement
![Page 415: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/415.jpg)
Case #184
53 year male
solitary plasmacytoma
proximal femur
![Page 416: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/416.jpg)
Pathologic fracture one year later
![Page 417: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/417.jpg)
Post op x-ray with
cemented long stem
biopolar prosthesis
![Page 418: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/418.jpg)
Case #185
55 year male
solitary plasmacytoma
proximal femur
![Page 419: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/419.jpg)
Case #185.1
40 year male with
increasing pain in
thigh for 6 mos
Solitary plasmacytoma
![Page 420: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/420.jpg)
Bone scan
![Page 421: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/421.jpg)
Sag T-1 PD FS Cor STIR
![Page 422: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/422.jpg)
Axial T-1
T-2
Gad
![Page 423: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/423.jpg)
PO interlocking nail
and cementation
![Page 424: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/424.jpg)
Case #946
49 year male
solitary plasmacytoma
acetabulum
![Page 425: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/425.jpg)
CT scan
tumor
![Page 426: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/426.jpg)
Bone scan
![Page 427: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/427.jpg)
Photomic
![Page 428: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/428.jpg)
Reconstruction with
metal cage
Steinman pin
![Page 429: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/429.jpg)
Cementation over metal
and completed THA
inside cage
![Page 430: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/430.jpg)
Post op X-ray
![Page 431: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/431.jpg)
Case #947
32 year male with solitary plasmacytoma acetabulum
tumor
![Page 432: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/432.jpg)
Coronal T-1 MRI
![Page 433: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/433.jpg)
Case #948
53 year male with
solitary plasmacytoma
sacrum
![Page 434: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/434.jpg)
R L
Bone scan shows signal void in tumor
![Page 435: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/435.jpg)
CT scan
tumor
![Page 436: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/436.jpg)
Sagittal T-2 MRI
tumor
![Page 437: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/437.jpg)
Case #949
52 year male with large solitary plasmacytoma pelvis
![Page 438: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/438.jpg)
CT scan at sacral level
![Page 439: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/439.jpg)
CT scan at lumbar level
tumor
![Page 440: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/440.jpg)
Case #950
45 year male with solitary plasmacytoma sacrum
![Page 441: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/441.jpg)
Lateral view
tumor
![Page 442: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/442.jpg)
Bone scan shows signal void in tumor site
![Page 443: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/443.jpg)
Bone scan
tumor
![Page 444: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/444.jpg)
Axial T-2 MRI
tumor
![Page 445: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/445.jpg)
Sagittal PD MRI
tumor
![Page 446: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/446.jpg)
Sagittal T-2 MRI
tumor
![Page 447: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/447.jpg)
Photomic
![Page 448: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/448.jpg)
Case #951
56 year male with solitary plasmacytoma sacrum
Axial T-1 MRI
tumor
![Page 449: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/449.jpg)
Sagittal T-1 MRI
tumor
![Page 450: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/450.jpg)
Case #952
28 year female with path fracture thru supra acetabular Solitary plasmacytoma
![Page 451: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/451.jpg)
Case #953
46 year male with
solitary plasmacytoma
proximal femur
![Page 452: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/452.jpg)
Coronal T-1 MRI
![Page 453: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/453.jpg)
Coronal T-2 MRI
![Page 454: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/454.jpg)
Case #954
65 year female with
solitary plasmacytoma
femur
![Page 455: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/455.jpg)
Post op x-ray with
blade-plate fixation
![Page 456: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/456.jpg)
Case #955
41 year male with
solitary plasmacytoma
femur
![Page 457: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/457.jpg)
Case #956
40 year female with
solitary plasmacytoma
proximal fibula
![Page 458: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/458.jpg)
Case #957
24 year male with solitary plasmacytoma scapula
tumor
![Page 459: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/459.jpg)
Bone scan showing signal void in center of tumor
![Page 460: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/460.jpg)
CT scan
tumor
![Page 461: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/461.jpg)
Multiple Myeloma
![Page 462: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/462.jpg)
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
![Page 463: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/463.jpg)
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.
![Page 464: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/464.jpg)
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.
![Page 465: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/465.jpg)
CLASSIC Case #186
65 year male with multiple myeloma pelvis and hips
fracture
![Page 466: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/466.jpg)
Photomic showing plasma cells
![Page 467: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/467.jpg)
Post op x-ray with THR right & ORIF left
R L
![Page 468: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/468.jpg)
Case #187
72 year male with multiple myeloma skull
![Page 469: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/469.jpg)
Punched out
lesions femur
![Page 470: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/470.jpg)
Case #188
55 year male with multiple myeloma spine
Sagittal T-2 MRI
![Page 471: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/471.jpg)
Sagittal T-2 MRI
lumbar spine with
evidence of cord
compression
![Page 472: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/472.jpg)
Case #958
37 year male with
multiple myeloma
dorsal spine
![Page 473: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/473.jpg)
Lumbar spine
![Page 474: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/474.jpg)
Autopsy specimens
![Page 475: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/475.jpg)
Photomic
![Page 476: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/476.jpg)
Case #959
55 year male with multiple
myeloma dorsal spine
![Page 477: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/477.jpg)
Lateral view
![Page 478: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/478.jpg)
CT scan showing tumor in vertebra and vertebral canal
![Page 479: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/479.jpg)
CT of adjacent vertebra
![Page 480: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/480.jpg)
Anterior vertebrectomy specimen
![Page 481: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/481.jpg)
Photomic
![Page 482: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/482.jpg)
Case #960
48 year male with
multiple myeloma
dorsal spine with
cord involvement
Sagittal T-2 MRI
tumor
![Page 483: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/483.jpg)
Axial T-2 MRI showing tumor in pedicle & costovertebral joint
![Page 484: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/484.jpg)
Another axial T-2 cut
tumor
![Page 485: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/485.jpg)
Biopsy photomic
![Page 486: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/486.jpg)
Case #961
55 year male with
multiple myeloma
cervical spine and
compression fracture
![Page 487: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/487.jpg)
Post op posterior
spinal fusion and
radiation therapy
![Page 488: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/488.jpg)
Case #962
38 year male with
multiple myeloma
lumbar spine
![Page 489: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/489.jpg)
Post op anterior
curettement and
cementation
![Page 490: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/490.jpg)
AP view
![Page 491: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/491.jpg)
Case #963
41 year male with
multiple myeloma
with collapsed vertebral
body and paraplegia
![Page 492: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/492.jpg)
Lateral view
![Page 493: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/493.jpg)
Case #964
16 year male with multiple myeloma lumbar spine
![Page 494: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/494.jpg)
Case #965
59 year female with multiple myeloma pelvis
tumor
![Page 495: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/495.jpg)
CT scan showing large aneuysmal lesion
tumor
![Page 496: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/496.jpg)
Another CT cut
tumor
![Page 497: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/497.jpg)
Post op x-ray with THA
with cement and
Steinman pins
![Page 498: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/498.jpg)
Skull x-ray showing multiple punched out lesions
![Page 499: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/499.jpg)
Case #966
72 year female with severe multiple myeloma pelvis
![Page 500: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/500.jpg)
Case #967
59 year female with multiple myeloma skull
![Page 501: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/501.jpg)
Same patient with scapular and humeral lesions
![Page 502: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/502.jpg)
Thumb lesion
![Page 503: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/503.jpg)
Case #968
55 year female with
multiple myeloma
with path fracture
femur
![Page 504: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/504.jpg)
Post op x-ray with cemented
long stem THA
![Page 505: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/505.jpg)
Case #969
75 year male with
multiple myeloma
and path fracture
femur
![Page 506: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/506.jpg)
Case #970
68 year female with multiple myeloma shoulder area
![Page 507: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/507.jpg)
Same patient with
tibial lesions
![Page 508: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/508.jpg)
Punched out
femoral lesions
![Page 509: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/509.jpg)
Punched out humeral
lesions as well
![Page 510: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/510.jpg)
Path fracture later on
with IM nail fixation
![Page 511: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/511.jpg)
Photomic
![Page 512: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/512.jpg)
Case #971
62 year male with
multiple myeloma
humerus
![Page 513: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/513.jpg)
Post op cemented Neer
prosthesis
![Page 514: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/514.jpg)
Case #972
37 year male with
multiple myeloma
upper extremity
with punched out lesions
![Page 515: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/515.jpg)
Case #973
48 year female with multiple myeloma shoulder
![Page 516: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/516.jpg)
Bone scan with
scapular and
rib lesions
![Page 517: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/517.jpg)
Coronal T-1 MRI
![Page 518: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/518.jpg)
Axial T-2 MRI
tumor
![Page 519: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/519.jpg)
Case #974
72 year male with
multiple myeloma
lumbar spine
![Page 520: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/520.jpg)
Same patient with
punched out lesions
in femur and ischium
![Page 521: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/521.jpg)
Also punched out lesions
in tibia and fibula
![Page 522: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/522.jpg)
Case #975
29 year male with blastic form of multiple myeloma
![Page 523: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/523.jpg)
Close up
![Page 524: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/524.jpg)
Case #976
40 year male with a
variant of multiple
myeloma known as
fibrogenesis imperfecta
ossium
![Page 525: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/525.jpg)
Multiple collapsed
lumbar vertebra as in
multiple myeloma
![Page 526: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/526.jpg)
X-ray at a later date
with progressive disease
![Page 527: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/527.jpg)
X-ray of pelvis shows diffuse lytic changes
![Page 528: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/528.jpg)
Bone scan
![Page 529: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/529.jpg)
Metastatic
Neuroblastoma
![Page 530: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/530.jpg)
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
![Page 531: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/531.jpg)
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.
![Page 532: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/532.jpg)
CLASSIC
Case #189
4 year male
metastatic neuroblastoma
distal femur with
pathologic fracture
![Page 533: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/533.jpg)
Lateral view showing
hair-on-end reactive
subperiosteal bone
formation
![Page 534: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/534.jpg)
Bone scan
![Page 535: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/535.jpg)
Bone scan shows abnormal
collection in kidney where
the primary tumor was
found
![Page 536: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/536.jpg)
Sagittal T-2 MRI
showing metastatic
tumor in tibia
![Page 537: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/537.jpg)
Abdominal CT scan showing primary neuroblastoma in the kidney area
tumor
![Page 538: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/538.jpg)
Chest x-ray showing multiple pulmonary mets
![Page 539: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/539.jpg)
Femoral biopsy photomic showing rosette pattern
![Page 540: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/540.jpg)
Higher power showing rosette pattern
![Page 541: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/541.jpg)
Case #977
7 year male with
metastatic neuroblastoma
proximal humerus and
path fracture
![Page 542: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/542.jpg)
Bone scan showing
primary tumor in kidney
and met to shoulder
![Page 543: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/543.jpg)
Photomic from humeral biopsy
![Page 544: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/544.jpg)
Case #978
9 year male with
metastatic neuroblastoma
proximal humerus
![Page 545: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/545.jpg)
Another view
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Case #979
1 year old female with
metastatic neuroblastoma
proximal humerus
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Case #980
5 year female with
metastatic neuroblastoma
proximal femur
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Case #981
11 year female with
metastatic neuroblastoma
femur treated with wide
resection and fibular strut
reconstruction
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Macro section from
resected specimen
showing tumor inside
and outside the femur
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Scanning lens photomic
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Higher power photomic
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Case #982
7 year male with
metastatic neuroblastoma
distal femur
![Page 553: Volume 8](https://reader031.fdocuments.us/reader031/viewer/2022013100/5455d23caf795940578b4b99/html5/thumbnails/553.jpg)
Case #983
7 month male with large
calcific renal mass which
on biopsy proved to be
neuroblastoma
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Lateral view
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Bone scan
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Bone scan
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Sag PD T-2