An Atlas of Musculoskeletal Oncology: Volume 2
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Transcript of An Atlas of Musculoskeletal Oncology: Volume 2
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Volume 2
Classic osteosarcoma-----------------Case 108-9 & 451-490 Bone forming pseudotumors-----Case 491-498
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Classic Classic Osteogenic Osteogenic SarcomaSarcoma
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Classic Osteogenic Sarcoma Osteogenic sarcoma is the most common primary malignanttumor of bone, making up 20 % of all primary malignancies,with approximately 500-1000 new cases diagnosed each year inthe United States. The classic or most common form of osteo-sarcoma is seen typically in children and young adults, with amale preference. It occurs in the metaphyseal areas of fast growingbones with the most common location being the distal femur,second the proximal tibia, and third the proximal humerus. 50% of the lesions will be found around the knee joint. This tumor is rare in in small bones such as the hand or the foot, or in vertebral segments. Patients usually present with spontaneous symptomsof pain in the area, followed several month later with a tumor mass that is usually diagnosed by biopsy within six months after onset of symptoms. The radiographic appearance of the lesionis typically a permeative lytic lesion seen in the metaphyseal area
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of a long bone with cortical breakthrough and periosteal elevation creating a Codman’s reactive triangle, followed later by a sunburstpattern of chaotic bone formation in the soft tissue outside the peri-osteal sleeve. In a small percentage of cases, a so-called skip lesion will appear as a separate nodule of tumor activity totally separatefrom the primary lesion which, when found, suggests a very poor prognosis for survival. Fifty percent of osteosarcomas are of the osteoblastic type, but in a smaller percentage of cases, there will be a prominence of cartilage or fibrous tissue that does not seem to influence the prognosis for survival. The staging process for this disease includes a MRI study of the primary tumor that helps identify soft tissue invasion by the tumorand defines the medullary extent of the tumor which helps the operating surgeon determine the level of amputation or limb salvage resection. A bone isotope scan is performed to rule out thepossibility of other bony foci in the skeletal system and a CT scanof the chest is obtained to rule out the possibility of metastatic
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disease to the lung. The final staging process includes a biopsyof the primary site performed in such a way as to not contaminatevital structures that might interfere with the potential for a limbsalvage resection at a later date. Prior to 1970, the prognosis for survival with this disease wasonly 20% even though early amputation was performed at a high level. Pulmonary metastasis was the reason for a fatal outcome inthese early cases, however, with the advent of multi-drug chemo-therapy the prognosis for survival has now increased to approx-imately 60%. The drugs most commonly used for systemic controlof the disease include high dose methotrexate, adriamycin, cysplatin, and ifosfamide. These drugs are administered througha central venous line on a cyclic basis every three to four weeksfor approximately two months prior to a surgical removal of the tumor. Chemotherapy is then continued for approximately fourmonths after surgical treatment. At the present time, 90% of patients with osteosarcoma are
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treated by limb salvage resection. The most common type ofreconstruction consists of a total joint replacement such as a rotating hinge at the knee. A smaller group of patients are treatedwith allograft reconstruction or combinations of the above. Excisional arthrodesis was a popular technique many years ago but now patients prefer a reconstruction that involves normal joint motion. The prognosis for survival is influenced by the degree of tumor necrosis produced by the preoperative chemo-therapy protocol, so that at the time of surgical resection if thereis more than 90% necrosis of the tumor, the patient has a muchbetter prognosis for survival (approximately 85% at five years).Pulmonary metastasis is still the major concern following treat-ment for osteosarcoma and, if this does occur, aggressive surgical resection of the lesions thru the chest wall is frequently performed. There is a 30% survival rate at five years following this procedure.As with other forms of cancer, recent molecular genetic studieshave revealed a high incidence of abnormality in the P-53 suppressor genes found in this tumor.
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CLASSICCase #108
16 yr maleclassic OGSfemur
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Bone scan
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Sagittal T-1 MRI
tumor
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Coronal T-2 MRI
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Axial T-1 MRI
tumor
tumor
vessels
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Axial T-2 MRI
tumor
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CT scan with pulmonary mets to lung
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Amputationspecimen
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Macro section
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Close up
Codman’striangle
tumor margin
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Photomic
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Higher power
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High power
tumorcells
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Case #109
14 yr maleclassic OGSfemur tumor
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Coronal T-1 MRI
tumor
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Coronal T-2 MRI
tumor
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Distal femoral resection and reconstruction with total knee replacement and Compress fixation
femur
measuring device
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Widely resected tumor specimen
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Reaming the proximal tibia
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Drill guide system
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Placing 5 transverse pins
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Traction bar protruding from femoral canal
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Tightening the compression nut inside spindle
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compression cap
compression nut
800 pounds of compressive fixation has been applied
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intercalarysegment
spindle
Intercalary segment attached to spindle
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Completion of rotating hinge arthroplasty
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AP x-ray appearancefollowing surgery
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anchor plug
spindle
Close up lateral
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Stable osseointegration5 years PO in another case
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Case #655
16 year femaleclassic OGSproximal femur
coronal T-2 MRI
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Axial T-2 MRI
tumor
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Widely resected specimen
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Distal femoral stump being prepared for placementof the spindle of the Compress reconstruction system
traction bar
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Spindle fixed to femur with 800 lbs pressure
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Proximal femoral replacement attached to spindle
spindle
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Proximal end of modular system with bipolar hip
attachment point for abductor tendon
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Hip located and ready for soft tissue attachments
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Soft tissue reconstruction completed with two fixation screws
vastus lateralis
abductor tendonfascia lata
screws
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Resected specimen cut in path lab
tumor
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Post op x-ray
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5 yrs PO
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Case #451
17 yr maleclassic OGSfemur
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Lateral view
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Sagittal T-1 MRI
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Proper biopsy site
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Photomic
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Resected specimenbiopsysite
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Specimen cut inpath lab showingextensive tumornecrosis
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Surgical defect following wide resection
patella
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Modular distal resection systemwith rotating hingedknee
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Rotating hingecomponents horizontal
axial
vertical axial
porous pads
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Reconstructioncompleted and ready for closure
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Radiographicappearance 7 yrs later
stress shielding
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Case #452
13 year male withClassic OGS distal femur
tumor
Codman’striangle
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Sagittal T-1 MRI
tumor
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tumor
vessels
Axial T-1 MRI
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Photomic
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Resected specimen
growth plate
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Expandable prosthesis with telescoping sleeveclosed down
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Telescopingsleeve opened
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Post op X-ray
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Case #453
23 yr femaleclassic OGSfemur
tumor
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Resected specimen
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Photomic
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Partially reconstructed
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Completed reconstruction
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Side view
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Immediate post opX-ray of cementedstem prosthesis
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13 yrs later with total failure fromsubsidence 2nd tostress shielding
neck fracture
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Surgical specimenat time of totalfemoral reconstruction
stress shielding
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X-ray after totalfemoral reconstruction
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Case #454
17 yr male with classic OGS proximal femur
tumor
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Lateral view
tumor
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Bone scan
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Coronal T-1 MRItumor
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Axial T-1 MRI
tumor
vessels
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Photomic
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Modular proximalfemoral resectionsystem
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Properly placed biopsy site over trochanter
incision
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Wide resectionspecimen
biopsysite
femoral head
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Cut specimenin path lab
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Surgical defect ready for reconstruction
acetabulum
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Hyperemic synovium in acetabular notch
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Suturing downabductor tendonto prosthesis
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Final soft tissuereconstruction
gluteus medius
vastus lateralis
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X-ray 7 yrs later
THA
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Case #455
7 yr male classic OGSdistal femur
tumor
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Bone scan
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Sagittal T-1 MRItumor
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Coronal T-2 MRI
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Axial T-1 MRI
vessels
tumor
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Surgical incision for turn-up-plasty
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Mobilizing prox tibia on vascular pedicle
vessels
tibia
femur
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Resected distal femurlaying next toinverted tibia
plate fixation
tibial plateau
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Post op stumpappearance readyfor suction socketprosthesis
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Post op x-ray
prox tibial epiphysis
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X-ray 18 mos later
tibial plateau
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5 years later
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Case #456
17 yr femaleclassic OGS withpathologic fractureand short plate fixation
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10 mos post op widesegmental resectionand double Compressspacer reconstruction
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Proximal Compressdevice showing goodosseointegration10 mos post op
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Amputation specimen 10 mos post op
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Excellent osseointegration at proximal end
anchor pins
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Case #457
32 yr maleclassic OGSmid femur
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Coronal T-2 MRI
Large extracortical mass
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Axial T-2 MRI
fluid
tumor
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Pathologic fracture after6 weeks on chemotherapy
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Coronal MRIthru fracture site
tumorfracture
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Gad contrast coronal MRI after 3 cycles of chemotherapy
necrotictumor rim
enhancement
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Surgical specimenfollowing wideresection
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Specimen cut in path lab
necrotictumor
fracture
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Macro section
necrotictumor
fracture
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Photomic
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Post op x-ray followingprosthetic reconstruction
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Case #458
13 yr maleclassic OGSdistal femur
tumor
![Page 122: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/122.jpg)
Lateral viewtumor
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Bone scan
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CT scan
tumor
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T-1 axial MRI
tumor
tumor
edema
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Coronal T-1 MRI
tumor
edema
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Sagittal T-1 MRI
tumor
edema
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Case #458.1
16 year old male with knee pain for 3 months
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Cor T-1 T-2 Gad
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Sag T-1 T-2 Gad
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Axial T-1 T-2
Gad
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Wide surgical resection and rotating hinge Compress recon
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Case #458.2
8 year female with classic OGS distal femur
![Page 134: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/134.jpg)
Cor T-1 MRI
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Cor T-2 Cor Gad
![Page 136: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/136.jpg)
Axial T-2
Axial Gad
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Case #459
11 yr male classic OGSproximal tibia tumor
![Page 138: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/138.jpg)
Lateral view
tumor
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Coronal T-1 MRItumor
![Page 140: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/140.jpg)
Coronal T-2 MRI
tumor
![Page 141: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/141.jpg)
Axial T-2 MRI
tumor
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Photomic
![Page 143: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/143.jpg)
15 year male with classic OGS proximal tibia
tumor
Case #461
![Page 144: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/144.jpg)
Lateral view
tumor
![Page 145: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/145.jpg)
Axial T-1 MRI
tumor
![Page 146: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/146.jpg)
Macro section
tumor
![Page 147: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/147.jpg)
Photomic
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Case #461.1AP & lat x-ray 3-05
17 year female dancer with prox. tibial pain for 3 mos withearly classic OGS looking like monototic fibrous dysplasia
![Page 149: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/149.jpg)
6-05
CT scan 3 months later
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Bone scan 7-05
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Axial & sagittal T-1 MRI 6-05
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Axial T-2 MRI 6-05
Axial T-1 FS Gad 6-05
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AP & lat x-ray 5 mos later 11-05 & obvious OGS
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Bone scan 11-05 biopsy proven OGS and placed on preop chemotherapy
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Coronal T-1 MRI 1-06 Sagittal T-1 MRI
Post chemo
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Axial T-2 MRI 1-06 Sagittal T-2 MRI following 2 mos of chemotherapy
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X-ray following wide resection & Compress TKA
![Page 158: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/158.jpg)
Case #462
14 year old female withClassic OGS distal tibia tumor
![Page 159: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/159.jpg)
AP view tumor
![Page 160: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/160.jpg)
Macro section
tumor
![Page 161: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/161.jpg)
Photomic
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Case #463
14 year femalenon-ossifying fibromatibia with no pain
Incidental finding
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4 years laterand no change
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14 yrs from 1st x-ray with sudden growth of tumor
![Page 165: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/165.jpg)
Bone scan
![Page 166: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/166.jpg)
Sagittal T-2 MRI tumor
![Page 167: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/167.jpg)
Axial T-2 MRI
tumor
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Photomic shows high grade classic OGS
![Page 169: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/169.jpg)
Case #464
14 year femaleclassic OGS fibula
![Page 170: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/170.jpg)
Another view
tumor
![Page 171: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/171.jpg)
Case # 465
8 year male with classic OGS proximal fibula
Codman’s triangle
tumor
![Page 172: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/172.jpg)
Case # 466
17 year maleclassic OGSproximal humerus
tumor
![Page 173: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/173.jpg)
Coronal T-1 MRI
tumor
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Axial T-2 MRItumor
![Page 175: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/175.jpg)
Widely resectedsurgical specimen
tumorbulge
humeralhead
![Page 176: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/176.jpg)
Specimen cut in path lab
![Page 177: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/177.jpg)
Photomic
![Page 178: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/178.jpg)
Surgical reconsructionwith allograft and longstem Neer prosthesis allograft
cement
Neer
![Page 179: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/179.jpg)
Post op x-ray
Neer
allograft
![Page 180: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/180.jpg)
Case #467
14 year female with classic OGS proximal humerus
![Page 181: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/181.jpg)
Resected specimentumor
![Page 182: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/182.jpg)
Cemented customprosthesis 5 years post op
![Page 183: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/183.jpg)
Case 468
16 year male withclassic OGS proxhumerus
![Page 184: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/184.jpg)
Widely resected surgical specimen
![Page 185: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/185.jpg)
Cut specimen in path lab
![Page 186: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/186.jpg)
Photomic
![Page 187: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/187.jpg)
Surgical defectready forreconstruction
glenoid
![Page 188: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/188.jpg)
Neer prosthesisin position
![Page 189: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/189.jpg)
Immediate post opappearance
![Page 190: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/190.jpg)
Case #468.1
18 year old male withclassic OGS proximalhumerus
tumor
![Page 191: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/191.jpg)
Widely resectedspecimen
![Page 192: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/192.jpg)
Surgical defectready forreconstruction
glenoid
![Page 193: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/193.jpg)
Cemented Neerprosthesis inposition
cement
![Page 194: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/194.jpg)
Appearance 9 mos laterwith proximal migrationof prosthesis
mets
![Page 195: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/195.jpg)
Case #468.2
14 year maleclassic OGSmid humerus
tumor
![Page 196: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/196.jpg)
Close up x-rayafter 1 mo of chemo
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T-1 MRI after 2 cyclesof chemotherapy
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T-2 MRI after 2 cyclesof chemotherapy
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Axial PD MRI
tumor
![Page 200: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/200.jpg)
Surgical specimenfrom shoulderdisarticulation
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Photomic
![Page 202: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/202.jpg)
Case #468.3
15 year female with Classic OGS proximalHumerus with path fracture
![Page 203: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/203.jpg)
Another view
fracture
![Page 204: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/204.jpg)
Case #469 CT scan
27 year female with classic OGS 10th rib
![Page 205: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/205.jpg)
2 years later develops 2nd OGS in R ilium
tumor
![Page 206: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/206.jpg)
CT scan thru tumor
tumor
![Page 207: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/207.jpg)
Another CT cut
tumor
![Page 208: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/208.jpg)
Bone scan
![Page 209: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/209.jpg)
Resected hemipelvis
tumor bulge
acetabulum
![Page 210: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/210.jpg)
Surgical specimenafter 3 mins inautoclave to killtumor ready forreimplantation
sciatic notch
acetabulum
![Page 211: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/211.jpg)
Autoclaved pelvis reimplanted with total hip reconstruction
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Post op x-ray appearance
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X-ray 2 years later with fracture thru ilium
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Case #470
18 year male with classic OGS pelvis
T-2 coronal MRI
tumor
![Page 215: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/215.jpg)
Axial T-2 MRI
tumor
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Entire hemipelvic resection specimen
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Total hip reconstructionprior to cementation
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Cement constructioncompleted
cement
constrainedtotal hip
![Page 219: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/219.jpg)
Immediate post op x-ray
CD rod
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Immediate post opX-ray showing CDrod reconstruction
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X-ray 2.5 years later
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Case #471
14 year male with classic OGS pelvis
tumor
![Page 223: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/223.jpg)
CT scan
tumor
![Page 224: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/224.jpg)
Axial T-2 MRI
tumor
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Coronal T-2 MRI
tumor
sparedacetabulum
![Page 226: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/226.jpg)
Rebar and cement reconstruction sparing hip
cement
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X-ray and CT appearance 10 years later
![Page 228: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/228.jpg)
![Page 229: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/229.jpg)
X-ray appearanceFollowing THA
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Case #472
26 year male with incidental fibrous cortical defect in ilium
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12 years later with classic OGS in same area
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Hemipelvic resectionincluding hip joint
tumorbulge
sciaticnotch
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Reconstruction withautoclaved hemipelvisand cemented total hip
autoclavedbone
THA
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Completed reconstruction
cement
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X-ray appearance two years later
![Page 236: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/236.jpg)
One year later the tumor recurred requiring the removal of the hip reconstruction as we see in this x-ray following which he died 1 yr later
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Case #473
23 year maleclassic OGSlumbo-sacral spine
tumor
![Page 238: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/238.jpg)
Lateral X-ray
tumor
L-5
![Page 239: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/239.jpg)
CT scan at L-5 - S-1 level
tumor
![Page 240: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/240.jpg)
Photomic
![Page 241: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/241.jpg)
Case #474
21 year maleclassic OGS L-3
![Page 242: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/242.jpg)
Bone scan
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CT scan
tumor
L-3
![Page 244: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/244.jpg)
Sagittal T-2 MRI
tumor
![Page 245: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/245.jpg)
Photomic
![Page 246: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/246.jpg)
Post op x-ray followingwide resection of L-3and reconstruction withanterior allograft andpedicle screws and plates
allograft
![Page 247: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/247.jpg)
Case #475
45 year female with classic OGS L-4
Sagittal T-1 MRI
tumor
![Page 248: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/248.jpg)
Axial T-2 MRI
tumor
![Page 249: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/249.jpg)
CT scan
tumor
![Page 250: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/250.jpg)
Case #476
20 year male classic OGSfirst metatarsal
![Page 251: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/251.jpg)
Lateral view
![Page 252: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/252.jpg)
Photomic
![Page 253: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/253.jpg)
Case #477
76 year female with classic OGS first metatarsal
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Lateral x-ray
tumor
![Page 255: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/255.jpg)
Case #478
17 year male classic OGSgreat toe
![Page 256: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/256.jpg)
18 mos laterwithout treatment
![Page 257: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/257.jpg)
Bone scan
![Page 258: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/258.jpg)
Post op x-ray followingresection and cancellousallograft reconstruction
![Page 259: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/259.jpg)
Case #479
18 year female with classic OGS 4th metacarpal
![Page 260: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/260.jpg)
Coronal gad contrast MRI
![Page 261: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/261.jpg)
Axial gad contrast MRI
![Page 262: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/262.jpg)
Another gad contrast cut
![Page 263: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/263.jpg)
2 year post op x-ray with allograft reconstruction
![Page 264: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/264.jpg)
Case #480
70 year male with soft tissue OGS foot
![Page 265: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/265.jpg)
AP view
![Page 266: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/266.jpg)
Photomic
![Page 267: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/267.jpg)
Case #481
55 year male with classic OGS talus
tumor
![Page 268: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/268.jpg)
Mortise view
tumor
![Page 269: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/269.jpg)
Case #482
19 year male with classic OGS os calcis
Macro section
tumor
subtalar joint
![Page 270: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/270.jpg)
Case #483
40 year female with classic OGS mandible
![Page 271: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/271.jpg)
Cut surgical specimen following hemimandibulectomy
tumor
![Page 272: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/272.jpg)
Case #484
75 year femaleclassic OGS mandible
tumor
![Page 273: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/273.jpg)
Case #485
36 year male with classic OGS lower rib
![Page 274: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/274.jpg)
18 mos later and no treatment
enlargedtumor
![Page 275: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/275.jpg)
Bone scan
![Page 276: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/276.jpg)
Case #486
25 year male with classic OGS rib
tumor
CT scan
![Page 277: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/277.jpg)
Another CT cut
tumor
![Page 278: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/278.jpg)
Photomic
![Page 279: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/279.jpg)
Case #487
29 year female with classic OGS clavicle
tumor
![Page 280: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/280.jpg)
Laminogram cut thru tumor
tumor
![Page 281: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/281.jpg)
Immediate post op x-ray following resection
![Page 282: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/282.jpg)
Case #488
21 year male with classic OGS patella
![Page 283: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/283.jpg)
Patellar view of tumor
![Page 284: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/284.jpg)
Case #489
19 year femaleclassic OGSulna
![Page 285: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/285.jpg)
Case #490
38 year maleclassic OGSscapula
tumor
![Page 286: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/286.jpg)
Bone Forming Bone Forming PseudotumorsPseudotumors
Stress fracturesCaffey’s diseaseBrown tumor of hyperparathroidismHemophiliaCompartment syndrome [late]Giant bone islandsOsteogenesis imperfecta
![Page 287: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/287.jpg)
Case #491
14 year old female withOGS pseudotumor tibia(stress fracture)
![Page 288: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/288.jpg)
Bone scan
![Page 289: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/289.jpg)
Coronal T-1 MRI
![Page 290: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/290.jpg)
Axial T-2 MRI
edema
![Page 291: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/291.jpg)
Photomic of callus formation
![Page 292: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/292.jpg)
Case #492
6 mo infant with pseudo OGS ulna which is Caffey’s disease
![Page 293: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/293.jpg)
Photomic of ulnar biopsy
![Page 294: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/294.jpg)
Transverse ulnar cut of amputation specimen
reactiveperiostitis
cortex
![Page 295: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/295.jpg)
X-ray showing hypertrophic changes in shoulder girdle
![Page 296: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/296.jpg)
Mandibular hypertrophic changes typical of Caffey’s
![Page 297: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/297.jpg)
Case 493
25 year female with pseudo OGS distal femur In reality a brown tumor of hyperparathyroidism
![Page 298: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/298.jpg)
Hemorrhagic giant cell response of brown tumor
![Page 299: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/299.jpg)
Thickened osteoid seams of hyperparathyroidism
![Page 300: An Atlas of Musculoskeletal Oncology: Volume 2](https://reader038.fdocuments.net/reader038/viewer/2022102804/5455b183af7959d2368b8a1c/html5/thumbnails/300.jpg)
Case #494
12 year old male withOGS pseudotumor distalfemur 2nd to pathologicfracture in hemophilia
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Lateral view
pseudotumor
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Case #495
44 year male with oldcrush injury to leg 25 yrs ago with ossifying compartmentsyndrome looking likesoft tissue OGS
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Case #496
64 year female with pseudo OGS distal femur in fact is a giant bone island
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Lateral view
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Bone scan
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Coronal MRI with low signal lesion
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Case #497
10 year female withOGS pseudotumor fromosteogenesis imperfecta
large fluffycallus
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X-ray 2.5 years laterwith healing fracture
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Case #498
14 year male with OGSpseudotumor second tochronic stress fractureproximal femur
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Biopsy shows hypertrophic reactive bone and no OGS