Pelvic bone tumor Quiz 3. Female 32 C/C: vague pelvic pain P/I: about 6-7 months ago.

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Pelvic bone tumor Pelvic bone tumor Quiz 3

Transcript of Pelvic bone tumor Quiz 3. Female 32 C/C: vague pelvic pain P/I: about 6-7 months ago.

Page 1: Pelvic bone tumor Quiz 3. Female 32 C/C: vague pelvic pain P/I: about 6-7 months ago.

Pelvic bone tumorPelvic bone tumor

Quiz 3

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Female 32 C/C: vague pelvic painP/I: about 6-7 months ago

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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

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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)

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Pelvic plain Radiography

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CT Scan

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What is D/D?What is diagnostic app?What is surgical app?

[email protected]

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AnswerAnswer

Our App.

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Our DD:

Benign lesion◦Enchondroma◦UBC◦ABC◦GCT

InfectionMalignancy

◦Chondrosarcoma◦Metastasis

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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

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Surgical app.◦Ant app.◦Post app.

Our app.◦ Localization ot tumor under VT guide Under local anesthesia◦ Dorsal app. With minimal incision

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Localization of the lesion

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Minimal incision

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Post operative Xray

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Two weeks post operative

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Pathology report

◦GCT

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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

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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

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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

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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

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The patient underwent 3.5 parathyroidectomy

She improved post operative, pain relief thenafter.

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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.

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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.

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Responsible surgeon, and prepare of the quiz

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