pelvic bone tumor quiz 3. female 32 c/c: vague pelvic pain p/i: about 6-7 months ago
TRANSCRIPT
Pelvic bone tumorPelvic bone tumor
Quiz 3
Female 32 C/C: vague pelvic painP/I: about 6-7 months ago
H/: ◦Pain: vague not related to activity or nocturnal◦Mild limping◦No constitutional symptoms (fever, weigth loss,
etc.) ◦Hip ROM was normal◦Laseque was negative◦FABER test was positive
Paraclinic◦Lab exam = N
◦( CBC, ESR, CRP, Ca, P, Alk Ph, BUN, Creat, FBS, RF, ELISA )
◦Plain X ray (as follow)
◦Bone scan◦ Increase uptake in pelvic close to SI Joint
◦CT Scan (as follow)
Pelvic plain Radiography
CT Scan
AnswerAnswer
Our App.
Our DD:
Benign lesion◦Enchondroma◦UBC◦ABC◦GCT
InfectionMalignancy
◦Chondrosarcoma◦Metastasis
Diagnostic app. Options;◦Biopsy
Needle biopsy Incisional biopsy Curettage and biopsy
◦Definitive treatment Curettage + BG, Bone cement, etc.
Our app;◦ Curettage biopsy without adjuvant therapy
Surgical app.◦Ant app.◦Post app.
Our app.◦ Localization ot tumor under VT guide Under local anesthesia◦ Dorsal app. With minimal incision
Localization of the lesion
Minimal incision
Post operative Xray
Two weeks post operative
Pathology report
◦GCT
Follow-up◦Two weeks
◦Pain relief ◦No limping
◦Three months◦Pelvic vague pain ◦Pelvic CT no changes
◦Six months◦No improve of the pain◦Pelvic MRI revealed the same tumor◦Consultation with three expertist
◦Nine months◦Candidate for operation
Follow-up◦Two weeks
◦Pain relief ◦No limping
◦Three months◦Pelvic vague pain ◦New pelvic CT no changes
◦Six months◦No improve of the pain◦Pelvic MRI revealed the same tumor◦Consultation with three expertist
◦Nine months◦Candidate for operation
Follow-up◦Two weeks
◦Pain relief ◦No limping
◦Three months◦Pelvic vague pain ◦Pelvic CT no changes
◦Six months◦No improve of the pain◦Pelvic MRI revealed the same tumor residue without recurence◦Consultation with three expertist , continue of physiotherapy
◦Nine months◦Candidate for operation
Follow-up◦Two weeks
◦Pain relief ◦No limping
◦Three months◦Pelvic vague pain ◦Pelvic CT no changes
◦Six months◦No improve of the pain◦Pelvic MRI revealed the same tumor◦Consultation with three expertist
◦Nine months◦Candidate for operation
The patient underwent 3.5 parathyroidectomy
She improved post operative, pain relief thenafter.
Discusion Discusion
Nowadays hyperparathyroidism revealed in lab examination in about 50% of cases.
Brown tumor as the presenting finding is so rare.
Ca and P occasionally is normal in the hyperpara specially in the beginning of the disease.
In retrospective evaluation in our patient, we found an increase of 24 h urine calcium in the preoperative lab examination.
We had to repeat laboratory examination when the symptoms had been continued.
Hyperparathyroidism must be in our differential diagnosis as our radiologist offered.
