|
Year |
2003 |
|---|---|
|
Question Number |
100 |
|
Category |
Orthopaedic Disease |
Question
Figures 26a through 26e show the plain radiograph, MRI scans, bone scan, and biopsy specimen of a 62-year-old man who has progressive left shoulder pain. Immunohistochemistry staining in the tissue is positive for leukocyte common antigen and negative for CD99. Staging studies show no disease elsewhere. What is the best local treatment?
1- Forequarter amputation
2- Extra-articular wide excision
3- Intra-articular wide excision
4- Intralesional curettage
5- Radiation therapy
Figures
Answer (click for answer)
Answer 5. This is lymphoma of bone. Staining with LCA is c/w lymphoma. CD99 is another round cell tumor, Ewings, which we wouldn’t expect in a 60 year old. X ray shows lytic and blastic changes. Path shows lymphocytes(predominately B-cells). Therapy is radio- and chemotherapy. Usually not surgery unless have fx or pending path fx.
Reference: Durr HR, Muller PE, Hiller E, et al: Malignant lyphoma of bone. Arch Orthop Trauma Surg 2002;122:10-16.
Ostrowski ML, Unni K, Banks PM, et al: Malignant lymphoma of Bone. Cancer 1986;58:2646-2655.