2b (Hip) - Answer: 20-year-old male has left hip pain when bearing weight

HISTORY: 

This 20-year-old male has left hip pain when bearing weight and pushing hip out anteriorly.


(QUIZ ANSWER) UNLIKELY DIFFERENTIAL DIAGNOSIS:

Lymphoma / Hodgkin’s disease


DIAGNOSIS:

Pending


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS

A large expansile mass of indeterminate character is 6.3cm long and 4cm in transverse dimension in a 20-year-old young male. Epimetaphyseal involvement all the way to the bone end is identified. Differential diagnosis includes the family of bone end lesions including giant cell tumor, chondroblastoma with or without clear cell chondrosarcomatous degeneration, telangiectatic osteogenic sarcoma (rare); however, in this position within the femur, the family of lymphoproliferative disorders is unlikely. Furthermore, the pattern of involvement is inconsistent with eosinophilic granuloma. The findings are definitively neoplastic in nature. Surrounding areas of osteoedema extend into the trochanteric crest.   

Scant reactive effusion.   

Lesion is solitary.  

Lesion is expansile.  

Tissue sampling will be necessary along with clinical history taking exclusion of any other potential sites of involvement although unlikely.  

Incidentally noted left hydrocele. Conventional radiograph is requested for further lesion characterization and matrix analysis.  

  

CONCLUSION:   

Expansile mass involving predominantly the epimetaphysis and epiphysis all the way to the bone end, of indeterminate aggression. Differential diagnosis given in the body of the report but first step is request for conventional radiograph and correlation of such.


Discussion
0 comments
  MSK MRI
  Neuro MRI
  Body MRI