Dr. Pepe’s Diploma Casebook: Case 25 – SOLVED!


Dear Friends,

This week I’m presenting the case of a 9-year-old child with pain in the leg after trauma.

1. Aneurysmal bone cyst
2. Simple bone cyst
3. Giant-cell tumour
4. Osteosarcoma

9-year-old child with pain in the leg after trauma

9-year-old child with pain in the leg after trauma

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    11 Responses to : Dr. Pepe’s Diploma Casebook: Case 25 – SOLVED!

    1. mariaT says:

      aneurysmal bone cyst

    2. Albert says:

      Lytic insuflating multiseptated epi-metaphyseal lesion in a 9y.o child. My initial though would be an aneurismal bone cyst (primary or secondary to a Giant Cell Tumor or even a Chondroblastoma). The fact that the metaphysis is still open makes GCT of bone very unlikely; although chondroblastoma could associate aneursimal bone component, it is quite rare and there is no evidence of chondroid matrix. The appearance does not go with Simple Bone Cyst. Two other diagnoses I think we should contemplate because of the age of the patient are the Brodie Abscess and the Eosinophilic Granuloma, the image does not favor any one of them. Other possibilities we can think of are the Fibrous Dysplasia, non-ossifying fibroma and more rare tumors like chondromyxoid fibroma; the appearance and location does not reminds me anyone of them.
      Finally, there are two images features that makes me worry and go against the initial diagnostic of Aneurysmal Bone Cyst. It seems to be soft-tissue component and evidence of cortical reaction in the lower pole of the lesion.
      With these two last features, I think you cannot stablish the benign diagnosis of an ABC and you should complete the study with an MRI with the suspicion of TELANGIECTATIC OSTEOSARCOMA.

    3. Ricardo Macareno says:

      Expansive lytic image with no break in the cortical proximal third of the fibula. Presents narrow transition zone and no periosteal reaction.
      The findings on plain radiographs and age are suggestive of aneurysmal bone cyst

    4. Adlin says:

      aneurysmal bone cyst

    5. muneesh sharma says:

      proximal fibular, lytic, expansile, bubbly meta-diaphyseal lesion, lucent matrix, in an unfused skeleton ; but the periosteal elevation and spiculated bony densities at the lower edge of the lesion are highly suspicious for a much more aggressive lesion than an ABC –

      final diagnosis telengiectatic osteosarcoma.

    6. genchi bari italia says:

      Lesione litica che “espande” l’osso: si esclude pertanto il TGC che è litico puro, senza “insufflazione dell’osso. La cisti semplice la si esclude perchè si vedono “spiculature” distali segni di pattern di tipo infiltrativo.Una cisti aneurismatica dovrebbe avere setti interni ossei e dovrebbe avere margini lisci.Rimane una “varietà dell’osteosarcoma, in passato definito aneurisma “maligno” dell’osso che è l’OS emorragico o teleangectasico:La rm fa diagnosi mostrando il segnale paramagnetico tipico del sangue ed emosiderina.

    7. D.NERMEEN says:

      an expansile lytic bone lesion at the proximal end of the fibula (meta-diaphyseal)with no cortical distruction and narrow zone of transition.not extentending to the articular surface, with evidence of internal septation, picture suggestive of aneurysmal bone cyst

    8. Rasul says:

      Giant cell tumour