Case Presentation: Femur Destruction Malignancy Osteomyelitis'

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Case PresentationFemur Destruction? Malignancy
? Osteomyelitis.

• Dr. Suyog Kulkarni
• Registrar Orthopaedics
• CWM Hospital
• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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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.

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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

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Normal X-Ray Hip - Feb. 2002
?
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On Traction June 2002
?
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After Biopsy June 2002
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Femur Destruction - June 2002
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Histopathology of Tumor

• Inflammatory granulation tissue
• Foci of abscess

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Histopathology of Tumor

• Inflammatory granulation tissue
• Foci of abscess
• Degenerating muscle

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Histopathology of Tumor

• Inflammatory granulation tissue
• Foci of abscess
• Degenerating muscle

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Histopathology of Tumor

• Inflammatory granulation tissue
• Foci of abscess
• Degenerating muscle

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Histopathology of Tumor

• Focus of chronic Abscess with plenty of plasma
  cells.

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Histopathology of Tumor

• Focus of chronic Abscess around blood vessel.

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Histopathology of Tumor

• Areas of new bone formation Callus formation.

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Histopathology of Tumor

• Areas of new bone formation Callus.

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Histopathology of Tumor

• Inflammation around degenerating muscle

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Follow up X-Ray July 2002
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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.

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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