Case Presentation:Case Presentation:Femur DestructionFemur Destruction? Malignancy ? Osteomyelitis.? Malignancy ? Osteomyelitis.

Pathology

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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 LFT’s - 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/L[6- 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