[Ortho] Остеобластокластома?

[Sandro Reverberi]

Dear Alexander,
I spent my early orthopaedic surgical experience at an Italian bone
tumor center. I have seen many GCTs of the bone, but none is similar
to that you presented. I hope that this is a my error, but it, in my
opinion, appears aggressive and strange in diaphyseal localization.
It seems in some aspects similar to a teleangectatic osteosarcoma, a
variant of osteosarcoma (characteristic gross appearance of
telangiectatic osteosarcoma is a multi-cystic "bag of blood".
Microscopically, telangiectatic osteosarcoma has large blood filled
spaces and thin septation. Within the septa there is scanty osteoid
production by the pleomorphic malignant cells. Giant cells are not
rare)
See also :  http://www.emedicine.com/orthoped/TOPIC566.HTM that says
"Microscopic features (of teleangiectatic osteosarcoma): 
Malignant cells are noted in a background of blood and necrotic
debris. Because the pleomorphic hyperchromatic malignant cells may be
diluted in the necrotic and hemorrhagic background, a careful
examination to recognize these elements is imperative. Blood lakes,
rather than endothelium-lined spaces, are present. In some cases, an
osteoid matrix may not be visualized except within the septal walls,
which may be thin and difficult to find. In such cases, a
characteristic radiographic appearance, when correlated with a
careful microscopic search for features suggestive of malignancy,
helps in the correct interpretation of the findings.25 In some cases,
low-power examination reveals a morphologic pattern that is
reminiscent of an aneurysmal bone cyst (see Image 1).
A potential trap is created by a radiologic impression of an
aneurysmal bone cyst and the characteristic gross features of that
cyst. However, examination of the cyst lining reveals overt malignant
cells, often with increased mitotic activity (see Image 2). These
cells may lie adjacent to the benign osteoclastic giant cells. In
some cases, these giant cells are numerous, and the tumor mimics a
giant, cell-rich osteosarcoma (see Image 3). Unlike an aneurysmal
bone cyst, telangiectatic osteosarcoma has an osteoid matrix that is
delicate and lacelike in appearance. Also, the stroma between the
dilated vascular spaces often contains malignant cells."
But what were anamnesis and clinical signs? had she pain?
This is an interesting case ; I thank you if you post next results.
Sandro Reverberi