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Re: Остеобластокластома вертлужной впадины
послал Christian Veillette 28 Сентябрь 2002, 19:41
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This is obviously a difficult case and most likely best managed by a specialist in orthopaedic oncology (if available).
More information is required for pre-operative planning.
The xray appearance is consistent with a bengin aggessive or malignant lesion involving both the acetablum and the femoral epiphysis (there appears to be erosions of the femoral head). The differential diagnosis would include non-tumor conditions such as Brown's tumor (a serum calcium should be measured), benign aggressive lesions such as GCT, ABC and chondroblastoma, and malignant lesions such as telangiectatic osteosarcoma and MFH of bone.
What were the results of the staging bone scan? Is this a solitary bone lesion? How was the initial biopsy performed? What was the delay in treatment of 12 month from the initial images?
Most important is cross-sectional imaging with MRI to obtain a better idea of the boney involvement as well as the soft tissue extension into the pelvis. In addition systemic staging including a CXR/CT scan of the chest is
important as GCT have metastatic potential (<5%) despite being "benign" lesions.
If this was a proximal tibia or distal femur then curretage, burring of the surfaces and either bone graft or cement augmentation and fixation would be the current management. In addition to adjuvant therapy which is
controversial.
However, the extent of the tumor in the pelvis and lack of a cortical rim leading to a large uncontained defect would be too much bone loss for any type of acetabular reconstruction.
A wide resection with reconstruction with a saddle modular prosthesis would be an option depending on the status of the remainder of the ilium.
I would be willing to run this by the orthosarcoma team on Monday rounds if you were to send me some images of the MRI and other details as above.
Interesting case!!
Christian
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Christian Veillette M.D., B.Sc.(Hon)
Orthopaedic Surgery Resident
University of Toronto
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