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  #1  
Old 11-27-2009
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Bones an accidentally discovered lesion

A 32 year old previosly healthy female patient, comes to the ER after she falls down from her bicycle to find herself unable to walk on her right leg, and localises severe pain just above the knee. An x-ray of that area shows a fracture of the lower femur, but also a lucent area with well defined borders is found arising at the lower femoral epiphysis just approaching the articular surface. Which of the following most likely shares the mode of spread of this lesion:

a- A brain tumor with pseudopalisading necrosis
b- A freely mobile breast lump in a teenage girl
c- A non resolving ulcer of the upper lip
d- Infective endocarditis in an iv drug abuser
e- A unilateral yellowish renal mass composed of clear cells
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  #2  
Old 11-27-2009
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I think the right answer is D
As she's probably having osteosarcoma which spreads hematogenously just like right sided infective endocarditis

Though am not sure about this
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  #3  
Old 11-27-2009
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osteoclatoma(gaint cell tumor of the bone ) ... have to share the same mode of spread ....

e- a unilateral yellowish renal mass composed of clear cells ??
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Old 11-27-2009
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Quote:
Originally Posted by smile135 View Post
osteoclatoma(gaint cell tumor of the bone ) ... have to share the same mode of spread ....

e- a unilateral yellowish renal mass composed of clear cells ??
Why did you pick Giant cell tumor? and why it shares the same mode of spread with renal cell carcinoma?
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Old 11-27-2009
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Quote:
Originally Posted by indrag View Post
Why did you pick Giant cell tumor? and why it shares the same mode of spread with renal cell carcinoma?
female,32,accidentally found- pathological #
occurs in lower femur epiphysis
x ray appearance- lucent area
.......... favours more to osteoclastoma rather than osteosarcoma

for osteosarcoma --- male , 10-25yrs, localized pain and swelling
lower femur but more commonly in metaphysis ,
X-ray - codman's triangle(periosteal elevation) , sunburst appearance

Osteoclastoma spreads hematogenously ..and so does RCC

it is my opinion only ..........let me know if I am wrong.........thanks
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  #6  
Old 11-28-2009
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Default Ann accidentally descovered

The answer should be e.
RCC has the same pattern of spread
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Old 11-28-2009
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you are absolutely true it's Giant Cell Tumor

Osteosarcoma as been said occurs in younger population, originates from metaphysis and usually respects the epiphyseal boundaries. GCT originates from the epiphysis and usually respects the articular surface boundaries.

GCT has been classically described as a locally invasive tumor; it invades locally in a similar fashion as malignant tumors though very rarely spreads distantly by lymphatics or blood.

I agree that this characteristic is losing popularity, to a lesser extent than Basal Cell Carcinoma of the skin (c). An ulcerative or nodular that commonly affects the upper lip, while a lower lip non resolving ulcer is suspicious of SCC.

a- is glioblastoma multiforme, spreads locally, by seeding in the CSF and rarely distally outside the CNS.
b- is fibroadenoma.

If you found the thread usefull, send feedback (thanks or posts). I'll provide more. If you don't, there's no need to share your feelings
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HouseWannabe (11-30-2009), indrag (11-28-2009), Laurentiu (11-28-2009), smile135 (11-28-2009)
  #8  
Old 11-28-2009
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I still don't know the answer

If it is Giant Cell tumor which spreads hematogenously then why we did not answer infective endocarditis in IV drug abuser?
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Old 11-28-2009
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GCT of bone does spread haematogenously very rarely. It's essentially described as locally invasive tumor as BCC of the skin (choice C)

GCT metastasize to the lung almost exclusively and only in 3% of cases

http://emedicine.medscape.com/article/1255364-overview
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