Caceres’ Corner: Case No. 36 (Update: Solution)

Dear Friends,

Since you are getting used to difficult cases, Muppet is showing you an easy one. May the Force be with you. It is a pre-op chest radiograph of a 37-year-old woman with breast carcinoma.

Diagnosis:

1. Metastases
2. Granuloma TB
3. Hydatid cyst
4. None of the above


37-year-old woman, PA chest

37-year-old woman, lateral chest

Click here for the answer to case #36

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    Oct 2012
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    DISCUSSION 13 Comments

    13 Responses to : Caceres’ Corner: Case No. 36 (Update: Solution)

    1. Jess says:

      here it goes… well-defined expansile lesion of the 3rd right rib anteriorly – ground glass matrix – this is most in keeping with fibrous dysplasia (renal cell carcinoma may characteristically give expansile lytic bone mets but breast cancer gives mixed lytic/sclerotic.)

      Answer D: NONE OF THE ABOVE

    2. Kelvin says:

      Agree with fibrous dysplasia – other considerations are enchondroma, though less likely due to the appearance.

      In older patients, we should also consider plasmacytoma and metastases.

    3. Dr Hesham says:

      non of the above
      begnin boney lesion

    4. vishal kalia says:

      Chest x-ray showing expansile lytic lesion involving the right 3rd rib anteriorly. no obvious soft tissue component seen in relation to it. other bones are normal. No lung lesions seen. cardiovascular shadow is normal. Soft tissue shadows are normal. The thoracic vertebrae are normal. no rib notching seen. The differential diagnosis of this apperance in an adult include-fibrous dysplasia,mets from RCC/thyroid, plasmacytoma, brown´s tumor, chondrosarcoma, paget´s disease.Diagnosis is fibrous dysplasia(young age and ground glass matrix, typical location). Mets from RCC and thyroid can be excluded on the basis of no previous history,no lung lesions, only single rib involvement(though it can occur),expansile lytic mets are not seen in breast CA, brown´s tumor in rib can be excluded on the basis of no other changes of hyperparathyroidism(like rib notching, rugger jersey spine, no history of chronic renal disease,normal visualised clavicles). Age is against paget’s and chondrosarcoma(also no arc or ring like calcifications seen within the lesion). Enchondroma and plasmacytoma are strong D/D.

    5. Albert says:

      I go with fibrous displasia in the anterior arch of 3rd rib.

    6. raslnp says:

      None of the above

    7. Xose says:

      Beware the muppet! He can be evil.
      Remember that Dr. Cáceres works in a mediterranean tertiary center, so I’ll go with Hydatid cyst.

    8. haber 61 says:

      non of the above
      begnin boney lesion

    9. Genchi Bari Italia says:

      Lesione espansiva dell’arco anteriore della 3 costa con caratteri semeiologici di Benignità( si esclude la metastasi).L’interessamento di una TBC, si può ragionevolmente escludere dalla negatività polmonare ed ilo-mediastinica.La cisti da echinoicocco dovrebbe avere un cercine osseo piu’ marcato.Rimane la osteolisi intracorticale, che”soffia” l’osso assotigliandone la corticale, come nella Displasia fibrosa , monostotica(escluderei l’encondroma, per la mancanza di evidenti tralci ossei intratumorali).

    10. Ricardo Macareno says:

      Expansive lesion is identified and low density defined ranges, which seems to depend on the portion of the third rib axillary right. It is suggestive of monostotic fibrous displasia.

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