Case Presentation: Femur Destruction Malignancy Osteomyelitis' - PowerPoint PPT Presentation

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Case Presentation: Femur Destruction Malignancy Osteomyelitis'

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Registrar Orthopaedics. CWM Hospital. Dr. Venkatesh M. Shashidhar. Senior Lecturer in Pathology ... Right hip hard large swelling, difficulty in walking ... – PowerPoint PPT presentation

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Title: Case Presentation: Femur Destruction Malignancy Osteomyelitis'


1
Case PresentationFemur Destruction? Malignancy
? Osteomyelitis.
  • Dr. Suyog Kulkarni
  • Registrar Orthopaedics
  • CWM Hospital
  • Dr. Venkatesh M. Shashidhar
  • Senior Lecturer in Pathology
  • Fiji School of Medicine

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

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

4
Normal X-Ray Hip - Feb. 2002
?
5
On Traction June 2002
?
6
After Biopsy June 2002
?
7
Femur Destruction - June 2002
8
Histopathology of Tumor
  • Inflammatory granulation tissue
  • Foci of abscess

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

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

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

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

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

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

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

16
Histopathology of Tumor
  • Inflammation around degenerating muscle

17
Follow up X-Ray July 2002
18
SERUM ELECTROPHORESIS(at Suva Private Hospital)
  • TOTAL PROTEIN - 90 GM/L 65- 85
  • ALBUMIN - 32 GM/L 38 -50
  • alpha-1-GLOBULIN- 7 GM/L 3-7
  • beta -1- GLOBULIN- 14 GM/L 5- 11
  • BETA GLOBULIN - 8 GM/L 4- 11
  • GAMMA GLOBULIN - 31 GM/L6- 15
  • Impression- Polyclonal hyper gamma
    globulinaemia. Pattern seen in patients with
    chronic inflammation autoimmune disorders,
    chronic liver diseases etc.

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