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"Osteosarcoma"- Case Presentation

"Osteosarcoma"- Case Presentation







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    "Osteosarcoma"- Case Presentation "Osteosarcoma"- Case Presentation Presentation Transcript

    • Presenting By- Dr. Golam Muhamud (Suhash).Prepared By-Dr. Md Nazrul IslamMBBS, M .sc. (B M E).
    • • She has h/o wt. loss, and loss of appetite but she has /had no complaints of pain, swelling and deformity in other parts of the body. She has no history of cough , haemoptysis, DM , HTN and asthma.• With these complaints she got herself admitted into Shaheed Suhrawardy Medical college Hospital for better management.
    •  She had no history of tuberculosis. Drug history:• H/O taking analgesic for 3 months but could not mentioned the name of drugs.
    • None of her family member suffered fromsuch illness.Personal history:Nothing contributory
    • • MP-4 to 6 days• MC-regular• Age of menarche-13yrs.
    • Immunized against –Tuberculosis& Tetanus
    • • Appearance- Ill looking• Body builds- Below average• Co-operation- Co-operated• Decubitus- Supine• Anaemia- Moderate• Jaundice- Absent• Cyanosis- Absent• Clubbing- Absent• Koilonychia-Absent• Lekonychia- Absent• Lymph nodes- Not palpable• Dehydration- No sign• Pulse - 84 Beat/min• Blood pressure- 100/60mm of Hg• Temperature-normal• Respiratory rate-16/min
    • Look-
    • Fluctuation test- negative,Trans-illumination test-negative,Patellar tap test- negative.Shortening of limb - 3 cm.Muscle wasting- Thigh – 4 cm. Leg – 2 cm Distal neurovascular status- normal Regional lympnodesnot enlarged.
    • Movement: walk with support. Left knee (ROM)– • Active flexion -Absent • Active extension-Absent • Patellar movement-Absent Left hip & ankle: normal range of movement
    • Locomotor systemGait: Can walk with supportInspection:Flexion attitude- Left knee(20 degree)Palpation: Tenderness – affected area. Spine: Normal
    • Higher psychic function: NormalCranial Nerve examination: NormalMotor function:Inspection: Gross Muscle wasting in left thigh & leg.
    • Deep tendon reflex: All jerks are present & normalSensory function test: All the sensory functions are normal.
    •  Inspection: Normal in size & shape of the chest- Respiratory rate: 16 /min Palpation: Trachea centrally placed, normal chest expansibility Percussion: Resonant all over the chest except right upper, middle and lower zone where dullness is present. Auscultation: Bronchial breathing sound with diminished breathing sound in Rt. Upper middle and lower zone.
    •  Pulse: 84 bts/ min B.P. 110/60 mm of Hg JVP: Not raised. Inspection: NAD Palpation: Apex beat in Lt 5thintercostal space, Percussion: superficial cardiac dullness presence over the precordium. Auscultation: s1& s2 is audible
    • • Inspection: nothing abnormality detected• Palpation: soft, non tender• Percussion: tympanic Auscultation: bowel sound present Per-rectal examination: normal findings.
    • Ms. Fatema, 18 years ill-looking, moderately anaemic, non icteric, nondiabetic, normotensive woman coming from Mirpur, Dhaka admitted in ShaheedSuhrawardy Medical College Hospital with thecomplaints of –• pain, just above the left knee joint 3 months back ,• swelling above the left knee joint 2 months back and• inability to walk for 1month.
    • • The pain was initially mild , fixed, non radiating, aching in nature but gradually it becomes intolerable which was aggravated during walking and worse at night & incompletely relived by taking NSAIDs.Thispain was not associated with fever.• She also noticed an ill defined swelling above left knee joint which was initially.
    • Small in size then it increases rapidly to a large size.It is associated with pain but not related to trauma.• She also gives H/O inability to walk due to pain,swelling and restriction of movement.• She gives H/O wt loss,loss of appetite but she has no H/O pain,swelling,deformity in other parts of body.
    • • On local examination- an ill defined diffuse swelling occupying over the supracondylar region of the left thigh with shiny skin and presents of engorged vein and wasting of the thigh and leg.• She has a deformity of knee and cannot walk without support.
    • • The surface of swelling smooth, margin- ill- defined, local temperature-raised , tenderness present, over lying skin is free, consistency-hard, not movable and fixed with underlying structure.• Shortening of the left limb was found 3 cm than the right. She was unable to walk without support.
    • • There was gross muscle wasting in left Lower limb, measuring thigh- 4cm, leg- 2 cm.• Neuromuscular status of left lower limb normal and regional lympnodes are not enlarged.Movement of the left knee joint absent hip and spine are normal.• On respiratory system examination-there was a dullness in Rt upper and lower zone of lung and breath sound also diminished in same area.Other system examination reveals no abnormality.
    • • Extensive bone destruction is seen in the left lower femoral shaft, condyles and tibialcondyles with soft tissue extension.• peripheral calcification also seen.• Bone destruction also seen in L5 vertebra.
    • Multiple metastatic nodules in both lungs along withRt. Sided Hydro-pneumothorax-
    •  S. creatinine 0.6 mg/ dl  Blood urea 30 mg / dl  S. calcium 7.5 mg / dl  S. alkaline phosphates 110 IU/ L  SGPT:26 IU/L , SGOT :33 IU/L  S. bilirubin:1.0 mg/dl• FNAC- Sarcomatous leison,suggestive of osteosarcoma.• Biopsy (incisional): Feature of osteosarcoma with osteod formation and many giant cells.