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MSK cases for discussion

MSK cases for discussion. Dr. Abdelaty Shawky Dr. Gehan Mohamed. Case 1.

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MSK cases for discussion

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  1. MSK cases for discussion Dr. Abdelaty Shawky Dr. Gehan Mohamed

  2. Case 1 • A 9-year-old boy complains of 2 weeks of pain in the hip. His temperature is 38.9°C. Laboratory studies show an elevated erythrocyte sedimentation rate. An X-ray reveals a mottled radiolucent defect in the upper femur, with abundant periosteal new bone formation.

  3. Fine-needle aspiration shows numerous neutrophils and cocci. Staphylococcus aureusis cultured from the bone lesion. A biopsy shows a fragment of necrotic bone embedded in fibrinopurulent exudate.

  4. M/E Dense neutrophilic infiltrate and necrotic bone

  5. M/E Inflammatory infiltrate surrounding a necrotic bone fragment

  6. Now answer • Your diagnosis of the case is…. • Most common site of affection is….. Why?? • Necrotic bone is called……. • Subperiosteal new bone formation is called…. • And openings through which pus is discharged are called…..

  7. Case 2 • A 10-year-old boy complains of pain and swelling around his right knee of 3 weeks' duration that has not improved with rest. His mother denies a history of trauma to the knee. A radiograph shows a destructive mass arising from the metaphysis of the distal femur

  8. RADIOLOGY • l • Plain radiograph • shows an ill-defined • destructive tumor in • the distal femur. • Sun ray appearance • Codman’s triangle

  9. Grossly • Irregular mass occupying the medullary part of metaphysis destroying the cortex. • Grayish white, with areas of hemorrhage.

  10. Microscopic examination

  11. Malignant spindle-shaped cells laying down osteoid matrix

  12. Now answer… • Your diagnosis of the case is…… • Most common site and age of the tumor is…… • Spread of this tumor is by….. and prognosis is….

  13. Case 3 • A 65-year-old man complains of pain in his back, fatigue • An X-ray examination reveals numerous lytic lesions • in the lumbar vertebral bodies. Laboratory studies disclose mild anemia, and thrombocytopenia. • Urinalysis shows 4+ proteinuria. A bone marrow biopsy discloses foci of abnormal plasma cell proliferation.

  14. Radiology, Gross Multiple osteolytic lesions in the skull , vertebrae and pelvic bones

  15. M/E Plasma cells with different grades of differentiation

  16. Now • What is your diagnosis of the case?.............

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