Ewing Sarcoma Osteomyelitis

Fig. 8.15 This Ewing sarcoma has destroyed the bone almost entirely—there is a pathological fracture (arrow). The margin of the defect is extremely irregular (moth-eaten, wide zone of transition). The periosteum tries to contain the tumor but in this frustrating process it has been displaced far laterally already.

Fig. 8.15 This Ewing sarcoma has destroyed the bone almost entirely—there is a pathological fracture (arrow). The margin of the defect is extremely irregular (moth-eaten, wide zone of transition). The periosteum tries to contain the tumor but in this frustrating process it has been displaced far laterally already.

Osteomyelitis Radiology

Fig. 8.16 This lesion also fulfills all the morphological criteria of malignancy. However, the young patient (see the configuration of the epiphyseal cartilage, which indicates an age between 15 and 17 years) complains about pain, fever, redness, and swelling in the area. Osteomyelitis is the most likely diagnosis in this case, and was confirmed histologically.

Fig. 8.16 This lesion also fulfills all the morphological criteria of malignancy. However, the young patient (see the configuration of the epiphyseal cartilage, which indicates an age between 15 and 17 years) complains about pain, fever, redness, and swelling in the area. Osteomyelitis is the most likely diagnosis in this case, and was confirmed histologically.

Kristeeze (75). Mrs. Kristeeze has been complaining about diffuse pains in the region of her left hip for quite some time now. Reading a good thriller has been much less fun than it used to be, she has lost weight, and she feels a bit feeble. Giufeng recognizes an ill-defined, sclerotic lesion in the left ischial bone as well as an irregular bone pattern in the left greater trochanter (Fig. 8.17).

^ Diagnosis: Paul has understood the importance of the clinical situation and the potential implications of his eventual diagnosis. He suggests a bone scan to prove the singularity of the lesion or to find further lesions of the same kind. In addition he recommends a leukocyte scintigraphy to exclude or verify an osteomyelitis. Deep in his heart he knows that histological proof must be achieved because Anthony has a malignant bone tumor until proven otherwise. Because any tissue biopsy will cause hemorrhages that can change the appearance of the tumor, he organizes an MR appointment right away. This examination will document the extent of the tumor within the bone marrow and the soft tissues to the surgeon and will establish the tumor volume at the outset of potential neoadjuvant, preoperative chemotherapy. Anthony now needs a good guardian angel and an experienced team of doctors.

f It is quite frequent that patients with a malignant bone i tumor recall some trauma at that site. This is mainly a psychological phenomenon that should not defocus our efforts to reach a conclusive diagnosis.

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