4.2
Average: 4.2 (5 votes)
Cystic lesion in proximal tibia
03/22/2012
Tags: Bone   Tibia   proximal   cystic bone lesion   bone lesion   
27 year old female patient with cystic lesion in medial part of tibia measuring 5 cm in diameter.
Biopsy of "cystic" lesion.
Macro: Granular brown and redish friable tissue fragments, mostly solid and with soft consistency, measuring 26 x 20 x 5 mm.
Benign or malignant? What is it?
Age:
27
Sex:
female
Condition:
Cystic lesion in proximal tibia
    DSCN6452as
    DSCN6459b
    DSCN6460c
    DSCN6461d
    DSCN6468
    DSCN6465
    DSCN6454as
    DSCN6458a
    CD1a
    S100

    Comments

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    25/04/12
    Interesting case, I put ABC
    ahmedaliPhD student. Graduate School of Medicine, Nagoya University, Japan
    0
    Interesting case, I put ABC solid type as 1st DD.
    08/04/12
    cells are blander than that
    abdofodaMansoura Faculty of Medicine Egypt
    0
    cells are blander than that of osteosarc., but also nuclei inside and outside ostoid areas look tha same which is seen with osteosarcoma. Great case, thanks for sharing.
    30/03/12
    Regarding the diff. dg.
    Viktor JovicInstitute of pathology, Ljubljana, Slovenia
    0
    S-100 or CD1a has being both negative, as presented in the additional slides added. That means, as far as I think, that Langerhans cell histiocytosis, as well as chondroblastoma has been (as much as immunocytochemistry allows) ruled out. Interestingly, Immunoquery site states 70% S-100 positivity in chondroblastomas, which is wrong, according to majority of papers analyzing IHC of chondroblastomas, as well according to our own experience, giving almost 100% positivity rate. As stated in the original Dahlin's article (see ref's) chondroid matrix is a prerequisite for designating a lesion as chondroblastoma. So far, in any of 5 additional sections analyzed, we have not found foci of these characteristic eosinophilic chondroid areas in our case.
    29/03/12
    Langerhans cell histiocytosis
    drkayceeUniversity of Limpopo-MEDUNSA CAMPUS
    0
    A very hypercellular composed of histiocytic proliferation.The neoplastic cells show nuclear grooves and nuclear identation with mitoses present.There are mucleated giant cells and eosinophils present.These histological features are suggestive of eisinophilic granuloma a.k.a Langerhans cell histiocytosis. CD1a & S100 are userful immunohistochemical markers.If positive,they are diagnostic. The definitive diagnosis will be confirmed by electron microscopy presence of Birbeck granules.
    29/03/12
    Case #31002
    0
    Aneurysmal bone cyst showing small & large vascular channels, giant cells of the osteoclast type, fibrous & osteoid tissue, & foci of hemmorrhage. No evidence of malignancy.
    28/03/12
    chondroblastoma . is it in
    A Qureshy LAHORE PAKISTAN
    0
    chondroblastoma . is it in epiphysis?
    28/03/12
    telangiectatic
    MÜLLERISSSTE
    0
    telangiectatic osteosarcoma mitosis, necrosis and osteoide material, are all present.
    27/03/12
    Aneurysmal bone cyst
    4
    No significant atypia. Can't see any cartilage or bone formation. Mostly histiocytes with very view scattered giant cells next to blood pools. Clinic fits also ABC.
    27/03/12
    Aneurysmal bone cyst , lot of
    5
    Aneurysmal bone cyst , lot of hemorrhoage admixed with giant cells
    27/03/12
    Very important diff. dg. that
    Viktor JovicInstitute of pathology, Ljubljana, Slovenia
    0
    Very important diff. dg. that should also be included, especially in this case is chondroblastoma. However, chondroblastoma is expected to contain areas of eosinophilic cartilage, as well as more ovoid cells and calcifications. At least 80% of chondroblastomas show S-100 positivity, but this one was negative. I agree that an epithelioid/oval cells in this lesion might divert one to think about chondroblastoma. I have to admit that the 1st marker by its importance in diff. dg. was S-100. However, its negativity doesn't exclude chondroblastoma, but overall (regarding histology) I was inclined to solid ABC, rather than chondroblastoma. It might be that chondroblastic component was not sampled during procedure, so that I will have to wait for curettage of this lesion to confirm this. Best regards
    27/03/12
    proximal tibia lesion
    drkellyrose7Emory Unviversity
    5
    Could this be a chondroblastoma?
    27/03/12
    i think it seemslangerhans
    aomidiaMashhad medical sceices universiy
    3
    i think it seemslangerhans cell histocytosis , so immunostain S100 and CD1a are requested.
    27/03/12
    langerhans cell histocytosis
    aomidiaMashhad medical sceices universiy
    0
    langerhans cell histocytosis , so immunostain S100 and CD1a are requested.
    27/03/12
    looks benign, ABC or
    nadirashifa international hospital
    0
    looks benign, ABC or fibroosseous lesion ? would also like to rule out osteitis fibrosa cystica... parathyroid function?
    26/03/12
    Fine point to include
    Viktor JovicInstitute of pathology, Ljubljana, Slovenia
    0
    Fine point to include Langerhans cell histiocytosis in the diff.dg. though, particularly in the later non-proliferative (fibrous, reparatory) phase of the disease, when eosinophils are often missing. I use to run a simple panel of antibodies in each unclassified fibro-osseous lesion, just in case not to miss eventual tumor (especially the ones that cause secondary ABC) and this one comprises the following: S100, SMA, desmin, cytokeratin (AE1/AE3) and CD34. By using that one could exclude the cartilaginous tumors (esp. chondroblastoma which often merges with ABC) LC histiocytoses and angiomatous tumors, briefly. When dealing with this kind of lesions I've almost never obtained positivity for any marker, with the exceprion of SMA, which often decorates fibroblasts/miofibroblasts. In this case S100 was negative, but to accentuate the point at the side of howayda Dabbas (since I also have a doubt, regarding late phase LCH), I have also included the CD1a, nevertheless, since it's more specific for LH histiocytosis, both found to be negative. I will include the IHC pics soon.
    26/03/12
    Cystic lesion in proximal tibia
    dh-dabbasprivate lab
    0
    I think of langerhans cell histocytosis , so immunostain S100 and CD1a are requested.
    25/03/12
    ABC
    drfatehiadubai medical college
    0
    It could be aneurysmal bone cyst: giant cells,vascular spaces,hemorrhages
    24/03/12
    tibia lesion
    nulickCrimean oncologic center
    4
    osteo Sa