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Vol 5 ppt

  1. 1. Volume 5 Malignant Chondroid TumorsPrimary central chondrosarcoma----------Case 125 & 652-678Secondary peripheral chondrosarcoma---Case 126 & 679-686Dedifferentiated chondrosarcoma---------Case 127 & 687-689Clear cell chondrosarcoma-----------------Case 128 & 690Mesenchymal chondrosarcoma------------Case 129 & 691Cartilaginous pseudotumors---------------Case 692-699
  2. 2. Chondrosacoma
  3. 3. Primary CentralChondrosarcoma
  4. 4. Primary Central Chondrosarcoma The primary or central conventional chondosarcoma is a lowgrade but malignant cartilagenous tumor found typically in adultsbetween the ages of 30 and 60 years. The tumor arises from themedullary canal of a large bone such as the pelvis, femur, tibia orproximal humerus. Because the tumor is slow growing, there islittle symptomatology and the tumor frequently becomes quitesizable before a physician is consulted. Primary chondrosarcomais extremely rare in small bones of the hand or foot. The meta-physeal portion of a long bone is the most common locationalthough diaphyseal locations are not unusual. 85% of centralchondrosarcomas are low grade lesions which on radiographicexamination demonstrate matrix calcification similar to that seenin benign enhondromas, whereas the high grade chondrosarcomas,which are rare, are frequently noncalcified and take on thepermeative appearance similar to other high grade sarcomas such
  5. 5. as fibrosarcoma and Ewing’s sarcoma. Histologically, the lowgrade central chondrosarcoma has a fairly well differentiatedchondroid matrix like that of an enchondroma but shows evidenceof permeative invasion into the adjacent cortical and cancellousstructures. There is rarely any mitotic activity in the low gradelesions. They have larger nuclear patterns with a higher degreeof atypicism compared to benign enchondromas. These low grade tumors have a good prognosis in terms of alow metastatic incidence to the lung but they must be treatedaggressively with a wide resection in order to prevent localrecurrence. One can not rely on adjuvant therapy such as radiationor systemic chemotherapy because these low grade lesions arenotoriously resistant to adjuvant therapy.
  6. 6. CLASSIC Case #125 50 year female with chondrosarcoma prox humerus
  7. 7. Axial T-1 MRI
  8. 8. Axial T-2 MRI
  9. 9. humeral headProximal humeralresection tumor bulge
  10. 10. Macro section
  11. 11. Close up macro section
  12. 12. Photomic
  13. 13. glenoidSurgical defectfollowing wideresection
  14. 14. rotator cuffProximal humeralallograft ready forimplantation
  15. 15. pectoralisAllograft placed Neerover long stemNeer prosthesis
  16. 16. rotatorAlloprosthetic cuffreconstructioncompleted pectoralis
  17. 17. Post op X-ray
  18. 18. Case #65274 femalechondrosacomaproximal humerus
  19. 19. Bone scan
  20. 20. Coronal T-1 MRI
  21. 21. Coronal T-2 MRI tumor
  22. 22. glenoidWide resectionproximal humerus
  23. 23. cortical erosion cortical erosionResected specimen cut in path lab
  24. 24. Photomic
  25. 25. Suturing down theallograft rotator cuffas part of the alloprostheticreconstruction
  26. 26. Post op x-ray withcemented Neeralloprosthesis
  27. 27. Case #65319 year malechondrosarcomaproximal humerus
  28. 28. tumorCoronal proton density MRI
  29. 29. Resected specimencut in path lab tumor
  30. 30. Macro section
  31. 31. Photomic
  32. 32. Case #654 28 year female with chondrosarcoma prox humerus
  33. 33. Coronal T-1 MRI
  34. 34. Axial proton density MRI
  35. 35. tumorAxial T-2 MRI
  36. 36. Case #65672 year malechondrosarcomafemur
  37. 37. Bone scan
  38. 38. Widely resecteddistal femoral specimencut in path lab
  39. 39. Close up showingcortical break thru
  40. 40. Photomic
  41. 41. Case #65783 year malechondrosarcoma femur
  42. 42. Case #65882 year femalechondrosarcomaproximal femur
  43. 43. X-ray resectedproximal femoraltumor with pathfractures
  44. 44. Macro section
  45. 45. Close up macro
  46. 46. Photomic
  47. 47. Case #65952 year malechondrosarcomamid femur
  48. 48. Another view
  49. 49. Bone scan
  50. 50. Coronal T-1 MRI
  51. 51. Macro section fromintercalary resection tumor
  52. 52. bone tumorPhotomic showing bony permeation
  53. 53. Photomic
  54. 54. Higher power
  55. 55. Post op X-ray
  56. 56. Case #660 54 year female with chondrosarcoma distal femur
  57. 57. patella Resected distal femur including entire knee joint
  58. 58. tumorDistal femur cut in path lab
  59. 59. tumor Macro section
  60. 60. articular cartilage articular cartilagetumor tumor tumor tumor Photomic
  61. 61. tumor boneClose up photomic showing bone permeation by tumor
  62. 62. Post op x-ray withexcisional arthrodesis I.M. nail
  63. 63. Case #660.1 33 year male with painless mass in popliteal space for 1 yr and restricted flexion of knee for 3 yrs
  64. 64. Sag T-1 T-2
  65. 65. Cor T-2 Axial T-2
  66. 66. Surgical specimen Compress rotating hinge
  67. 67. PO x-rays
  68. 68. Case #66158 year malechondrosarcomaproximal tibia tumor
  69. 69. Lateral view
  70. 70. Resected specimen cut in path lab
  71. 71. Photomic
  72. 72. spherocentric kneeProximal tibial allograftplaced over long stemtotal knee replacementwith wires for patellartendon attachment
  73. 73. Patellar tendonsutured to proximaltibial allograft
  74. 74. patellaCompletion ofretinacular closure
  75. 75. Post op x-ray allograft
  76. 76. 9 years later
  77. 77. Case #662 43 year male with chondrosarcoma proximal tibia
  78. 78. Coronal T-2 MRI tumor
  79. 79. Sagittal Gad C MRI
  80. 80. Axial T-1 MRI tumor
  81. 81. Proximal tibial resection with tumor breakout posterior
  82. 82. anchor plug drill spindleProximal tibial resection prosthesis with Compress System
  83. 83. Resected proximal tibia next to prosthesis
  84. 84. Drilling holes foranchor plug pinsin tibia guide
  85. 85. Placement of anchor plug and traction bar
  86. 86. millMilling the proximal tibial stump
  87. 87. Milling processcompleted readyfor spindle placementover traction bar
  88. 88. spindleSpindle secured with 600 lbs of spring pressure
  89. 89. Femoral component of rotating hinge cemented in place
  90. 90. Components assembled ready for patellar ligament attachment
  91. 91. Spiked washers secure patellar ligament
  92. 92. Soft tissue reconstruction completed ready for closure
  93. 93. Post op x-ray
  94. 94. Case #66363 year femalechondrosarcomapelvis
  95. 95. sciatic notch acetabulumInternal hemipelvectomy resection specimen
  96. 96. sciatic notch acetabulum Resected specimen after autoclaving
  97. 97. Autoclaved specimenreplaced with routinecemented total hip
  98. 98. upper resection lineImmediate post opX-ray showing rebarand cement fixation
  99. 99. 15 years later
  100. 100. Case #664 54 year male with chondrosarcoma mid pelvis
  101. 101. CT scan
  102. 102. Bone scan
  103. 103. Type II internal hemipelvectomy resection
  104. 104. Type II resection tumorspecimen femoral head
  105. 105. Photomic
  106. 106. Autoclaved specimen
  107. 107. Autoclaved specimenreimplanted withcemented total hip &recon plates
  108. 108. Nine years later
  109. 109. Case #665 47 year female with chondrosarcoma mid pelvis
  110. 110. tumor CT scan
  111. 111. tumor Coronal T-1 MRI
  112. 112. tumor Coronal T-2 MRI
  113. 113. Photomic
  114. 114. X-ray 1 year post op internal hemipelvectomy & THA
  115. 115. 4 years post op
  116. 116. 8 yrs PO with slight lateral shift of cup
  117. 117. Case #666 45 year female with chondrosarcoma mid pelvis
  118. 118. Coronal T-2 MRI
  119. 119. Cutting ilium with Gigli saw
  120. 120. ischium ilium ant ramusPlacement of 6.5 screws in ilium, ischium & ant ramus
  121. 121. iliac screwsReconstruction of pelvic ring with recon plates
  122. 122. Placement of constrained cup prior to cementing
  123. 123. Cup cemented
  124. 124. Resected ilium & socket lying next to reconstruction
  125. 125. Hip relocated ready for greater troch attachment
  126. 126. Skin closure including biopsy site
  127. 127. Post op x-ray
  128. 128. Post op x-ray
  129. 129. Case #666.1 Chondrosarcoma pelvis 7-08 8-09 55 year old female with mild left hip pain for 4 years
  130. 130. Cor T-1 T-2 gad
  131. 131. Axial T-1 T-2 Gad
  132. 132. Sag T-2 Gad
  133. 133. Internal hemipelvectomy
  134. 134. Post op x-ray
  135. 135. Case #66750 year malechondrosarcomaanterior acetabulum
  136. 136. Bone scan
  137. 137. Axial T-1 MRI
  138. 138. Type II & III resection and rebar and cement total hip
  139. 139. Case #667.1 78 yr male with primary chondrosarcoma pelvis
  140. 140. Axial T-1 MRI
  141. 141. Axial T-2 MRI
  142. 142. Axial Gad MRI showing rim enhancement
  143. 143. Coronal T-1 MRI
  144. 144. Coronal T-2 MRI
  145. 145. Coronal Gad MRI
  146. 146. Case #667.2 Recurrent chondrosarcoma 56 yr old female with prior excision of pelvic tumor 4 yrs ago
  147. 147. Current MRICor T-1 T-2 Gad
  148. 148. Axial T-1 T-2Gad
  149. 149. Sag gad Surgical specimen
  150. 150. Case #668 43 year male with chondrosarcoma body of scapula
  151. 151. 7 years later
  152. 152. CT scan
  153. 153. tumorAnother CT cut
  154. 154. tumorCoronal T-2 MRI
  155. 155. tumorAxial T-2 MRI
  156. 156. Total scapular prosthesis
  157. 157. Cementing humeral component
  158. 158. Scapular component positioned in muscle cuff
  159. 159. Closure of muscle cuff over scapular component
  160. 160. tumor bulgeResected scapula and humeral head
  161. 161. Post op x-ray
  162. 162. Case #669 tumor 47 year male with chondrosarcoma scapular body
  163. 163. tumorAnother CT cut
  164. 164. tumorAxial proton density MRI
  165. 165. tumorAxial proton density MRI
  166. 166. tumorAxial T-2 MRI
  167. 167. tumorCoronal proton density MRI
  168. 168. Case #669.1 Chondrosarcoma Scapular Wing 52 yr male with none tender lump over upper scapula for 6 mos.
  169. 169. Axial T-2 Gad
  170. 170. Sag GadSag T-2
  171. 171. Surgical specimen
  172. 172. Case #670 52 year male with chondrosarcoma elbow
  173. 173. Cut specimen in path lab
  174. 174. Photomic
  175. 175. Case #670.1 76 year female with slow growing chondrosarcoma elbow
  176. 176. Axial T-1T-2 T-2
  177. 177. Sag T-1 Sag STIR
  178. 178. Cor T-1 Cor STIR
  179. 179. Surgical debulking
  180. 180. Case #67126 year malechondrosarcomaradius
  181. 181. Coronal T-1 MRI
  182. 182. Photomic
  183. 183. Case #672 36 year male with chondrosarcoma distal radius
  184. 184. CT scan
  185. 185. Case #67356 year maleenchondroma2nd metacarpal
  186. 186. 3.5 years later withchondrosarcoma
  187. 187. Photomic
  188. 188. Case #674 77 year female with chondrosarcoma os calcis
  189. 189. Os calcis view
  190. 190. T-1 MRI
  191. 191. tumorT-2 MRI
  192. 192. tumorSagittal T-2 MRI
  193. 193. Photomic
  194. 194. Case #674.1 Chondrosarcoma ankle 55 year male with slight pain and swelling about ankle for 2 years
  195. 195. Bone scan
  196. 196. CT Scan
  197. 197. Sag PD T-2 Gad
  198. 198. Axial PD T-2 Gad
  199. 199. Case #674.2 Chondrosarcoma os calcis 40 year male with 2 yr history of swelling medial ankle
  200. 200. Axial T-1 T-2 T-2 FS Gad
  201. 201. Cor T-1 STIR Gad Sag Gad
  202. 202. Case #675 tumor 72 year male with chondrosarcoma chest wall
  203. 203. tumorLateral view
  204. 204. CT scan
  205. 205. Another CT cut
  206. 206. Photomic
  207. 207. Case #676 52 year male with chondrosarcoma rib
  208. 208. rib tumor Macro section of resected specimen
  209. 209. Photomic
  210. 210. Case #676.138 year malechondrosarcomaL-1 with block onmyelogram
  211. 211. CT scan
  212. 212. Photomic
  213. 213. Case #676.274 yr male with low grade chondrosarcoma LD spine 2 yrs
  214. 214. CT scan
  215. 215. Sag T-1 Sag T-2 Sag Gad
  216. 216. Axial T-1 Axial T-2 Axial Gad
  217. 217. Case #676.3 Chondrosarcoma L-3 48 year old male with low back pain for 1 year
  218. 218. Bone scan
  219. 219. Axial T-1 T-2
  220. 220. Sag T-2
  221. 221. Case #677 46 year male with chondrosarcoma mandible
  222. 222. Photomic
  223. 223. Case #67839 year malechondrosarcomamandible
  224. 224. Secondary PeripheralChondrosarcoma
  225. 225. Secondary Peripheral Chondrosarcoma The vast majority of secondary peripheral chondrosarcomas arisefrom a prexisting osteochondroma and do not occur before puberty.These lesions tend to be slow growing with minimal to mildsymptoms. The most common site is the pelvis, followed by theproximal femur, proximal humerus, and ribs. Plain radiographs showa large calcifying mass on the surface of bone that measure over5 cm in girth. When one sees an osteochondroma with a cartilagenouscap over 3 cm in thichness, there is a strong likelihood for asecondary chondrosarcoma. The overall prognosis for the secondaryperipheral chondrosarcoma is much better than that for the primarycentral chondrosarcoma and usually requires only a simple wideresection with little chance for local recurrence.
  226. 226. CLASSIC Case #126 exostosis tumor56 year male with 2ndary peripheral chondrosarcoma ilium
  227. 227. Coronal T-2 MRI tumor
  228. 228. iliumResected specimen cut in path lab
  229. 229. iliumMacro section
  230. 230. Low power photomic
  231. 231. Higher power with ditto forms
  232. 232. Case #679 60 year female with chondrosarcoma pubic area
  233. 233. tumorGross resection specimen
  234. 234. tumor pubic boneGross specimen cut in path lab
  235. 235. tumor pubic boneMacro section
  236. 236. pubic boneClose up macro section
  237. 237. Photomic
  238. 238. Post op x-ray
  239. 239. Case #680 exostosis31 year malechondrosarcoma tumorilium in multipleexostosis patient
  240. 240. exostosis tumorAxial proton density MRI
  241. 241. Axial T-2 MRI tumor
  242. 242. tumorAxial T-2 MRI
  243. 243. Photomic
  244. 244. X-ray of knees with multi exostoses
  245. 245. Case #68118 year femalechondrosarcomapelvis and multihereditary exostoses
  246. 246. Oblique view
  247. 247. CT scan
  248. 248. tumorBone scan
  249. 249. tumorResected specimen
  250. 250. Macro section
  251. 251. Photomic
  252. 252. Multi exostoses knee
  253. 253. Lateral view
  254. 254. Several years after type I resection
  255. 255. Case #682 38 year female with osteochondroma C-spine
  256. 256. CT scan
  257. 257. Surgical photo at time of surgery
  258. 258. capSurgical specimen cut in path lab
  259. 259. Recurrence 3 yearslater
  260. 260. Recurrence CT scan
  261. 261. Coronal T-1 MRIof recurrence withchondrosarcoma tumor
  262. 262. Chondrosarcoma photomic
  263. 263. Case #683 42 year female with 2ndary chondrosarcoma ilium
  264. 264. CT scan
  265. 265. tumorCoronal T-1 MRI
  266. 266. tumorAxial T-1 MRI
  267. 267. tumorAxial T-2 MRI
  268. 268. Case #68433 year male2ndary chondrosarcomaos calcis
  269. 269. Lateral view
  270. 270. CT scan
  271. 271. chondrosarcSoft tissue CT scan exostosis
  272. 272. tumorCoronal proton density MRI
  273. 273. tumorCoronal T-2 MRI
  274. 274. Surgical specimen cut in path lab
  275. 275. Photomic
  276. 276. Case #685 30 year male with multi exostoses & chondrosarcoma chest wall
  277. 277. Case #686 42 year male with 2ndary chondrosarcoma
  278. 278. chondrosarc bone stock Macro section
  279. 279. Case #686A 42 year male with peripheral chondrosarcoma ulna
  280. 280. DedifferentiatedChondrosarcoma
  281. 281. Dedifferentiated Chondrosarcoma Of all the chondrosarcoma variants, by far the most malignant andpotentially fatal is the dedifferentiated chondrosarcoma thataccounts for approximately 5-10% of all chondrosarcomas. Itmost likely arises as a result of a second mutation within a pre-existing low to intermediate grade chondrosarcoma, resulting inthe formation of a malignant fibrous histiocytoma or osteo-sarcoma immediately adjacent to the lower grade chondrosarcoma.Histologically, the low and high grade portions of this tumor aregeographically separated by sharp margins. These tumors usuallyoccur in patients between the ages of 50 and 70 years in thesame areas where primary central chondrosarcomas are found:the pelvis, femur and proximal humerus. The characteristicradiographic appearance is that of a flocculated calcific lyticlesion arising from the central area of bone with an adjacent areawith more extensive infiltration into the surrounding cortical bone.
  282. 282. There is no evidence of calcification in the high grade portion of thelesion and it typically breaks through the cortex and into thesubperiosteal space. The prognosis for this variant of chondrosarcomqa is extremelypoor, most patients dying from metastatic disease within one or twoyears after the diagnosis is established. Adjavent chemotherapy orradiation therapy is not very effective, mainly because of the olderage group in which the tumor occurs. The primary treatmentmodality is wide surgical resection.
  283. 283. CLASSICCase #12744 year malededifferentiatedchondrosarcomaproximal femur
  284. 284. 2 years later withincreased size
  285. 285. Coronal T-1 MRI tumor
  286. 286. tumorAxial T-2 MRI
  287. 287. Photomic at juncture of high and low grade tumor
  288. 288. Low grade chondrosarcoma portion
  289. 289. osteoidHigh grade OGS portion
  290. 290. Case #127.1 Dedifferentiated chondrosarc63 yr male with recenthip fracture
  291. 291. Bone scan
  292. 292. Cor T-1
  293. 293. Sag T-1 STIR
  294. 294. Axial PDAxial PD
  295. 295. Surgical resection
  296. 296. Rconstruction completed
  297. 297. Post op X-ray
  298. 298. Case #687 high grade73 year femalededifferentiatedchondrosarcomadistal femur low grade
  299. 299. high gradeLateral view low grade
  300. 300. Bone scan
  301. 301. highCoronal T-1 MRI low
  302. 302. high grade low grade Resected distal femur cut in path lab
  303. 303. Photomic showing low grade left & high grade right
  304. 304. Low grade chondrosarcoma
  305. 305. osteoid High grade OGS
  306. 306. Post op x-ray withprosthetic recon
  307. 307. Case #68833 year femalededifferentiatedchondrosarcomadistal femur
  308. 308. 400 lbs pressureReconstruction with Compress system after wide resection
  309. 309. Completion of rotating hinge arthroplasty
  310. 310. Immediate post op x-ray
  311. 311. X-ray at 2 months showingearly callous formation
  312. 312. anchor plugEarly osseointegrationat 5 months spindle
  313. 313. X-ray at one year
  314. 314. Stable osseointegrationat 5 years with no signsof stress shieldingAP view
  315. 315. anterior cortexLateral view
  316. 316. 10 years post op
  317. 317. 16 years post op
  318. 318. Case #688.1 Dedifferentiated chondrosarcoma 89 year male with mild knee pain 3 months
  319. 319. Coronal T-1 T-2 Sagittal T-2
  320. 320. AxialT-1 T-2 Gad
  321. 321. Immediate Post Op x-rays
  322. 322. Case #68942 year femalededifferentiatedchondrosarcomapelvis
  323. 323. Bone scan
  324. 324. Sagittal T-1 MRI tumor post column acetabulum
  325. 325. Axial T-1 MRI
  326. 326. tumor Coronal T-2 MRI
  327. 327. Low power photomic
  328. 328. Low grade chondrosarcoma
  329. 329. High grade portion
  330. 330. recon plate Internal hemipelvectomy reconstruction
  331. 331. Post op x-ray
  332. 332. Case #689.1 Dedifferentiated Chondrosarcoma 42 year male with right hip pain for 3 months
  333. 333. Bone scan
  334. 334. CT scan
  335. 335. Cor T-1 STIR Gad Gad
  336. 336. Axial T-1 T-2 T-2 Gad
  337. 337. Case #689.2 Dedifferentiated Chondrosarcoma55 yr male from Hawaii with painful mass R hip 4 mos
  338. 338. Cor T-1 STIR Gad
  339. 339. Sag T-1 STIR Gad
  340. 340. Axial T-1 STIR Gad
  341. 341. Clear CellChondrosacoma
  342. 342. Clear Cell Chondrosarcoma The clear cell chondrosarcoma is one of the rarest variants of thechondrosarcoma. It is found more commonly in males than femalesbetween the ages of 20 and 50 years. The most common locationfor this tumor is in the femoral head. Radiographically the clear cellchondrosarcoma has the appearance of a lytic lesion in the epiphysis,similar to the chondroblastoma in a younger age group for which itis frequently misdiagnosed. It has a geographic pattern with centralstippled calcification similar to that of a chondroblastoma. Histo-locally it also has the appearance of a chondroblastoma with thepresence of benign macrophages and polyhedral stem cells with aclear cell chicken wire appearance. But in some areas one will seeevidence of a low grade chondrosarcoma in which giant cells are notseen, clearly separating it from the chondroblastoma. The treatment for this condition consists of a wide resection whichin the femoral head would be a transcervical resection and replace-
  343. 343. ment with a bipolar prosthesis. If the lesion is treated by simplecurettement, the recurrence rate is quite high compared to thechondroblastoma. The chance for pulmonary metastasis is veryunlikely and local recurrence is rare following a wide resection.
  344. 344. CLASSIC Case #12825 year male with clear cell chondrosarcoma femoral head
  345. 345. Low power photomic
  346. 346. Higher power showing clear cells
  347. 347. Case #69051 year male with clear cell chondrosarcoma femoral head
  348. 348. Frog leg lateral
  349. 349. Post op x-ray followinghead & neck resectionand total hip replacement
  350. 350. Case #690.1 Clear cell chondrosarcoma Post reduction Acute pathologic fracture left shoulder in 43 yr female
  351. 351. CT scan
  352. 352. Cementation PO
  353. 353. Case #690.1 20 year female with clear cell chondrosarc prox tibia
  354. 354. Lateral view
  355. 355. tumorCoronal T-1 MRI
  356. 356. Sagittal T-1 MRI tumor
  357. 357. MesenchymalChondrosarcoma
  358. 358. Mesenchymal Chondrosarcoma The mesenchymal chondrosarcoma is another rare variant of thechondrosarcoma. It consists of low grade chondrosarcoma com-ponents with an infiltration of primitive mesenchymal cells givingit the histological appearance of a Ewing’s sarcoma or a hemangio-pericytoma. It can be seen in soft tissue as well as bone in youngadults, more often in females. The most common location is in thejaw, followed next by the spine or ribs, with a very few cases seenin long bones. Because of the high grade component of this lesion,it is treated as a high grade sarcoma with adjavent chemotherapyand radiation therapy along with a wide resection if possible.Despite this aggressive program of treatment, the prognosis is verypoor because of a high incidence of pulmonary metastases andlocal recurrence.
  359. 359. CLASSICCase #12934 year femalemesenchymalchondrosarcoma tumorLD spine & paraplegiaSagittal MRI
  360. 360. Photomic showing low grade chondroid portion
  361. 361. High grade round cell portion of tumor
  362. 362. Case #691 tumor36 year male with mesenchymal chondrosarc humeral head
  363. 363. CT scan
  364. 364. Post op x-rayfollowing humeralhead resection andprosthetic recon
  365. 365. CartilagenousPseudotumors
  366. 366. Case #692 Pseudotumor8 year female with multi focal TBc looking like Ollier’s
  367. 367. Geographic lesions in both elbows
  368. 368. Langhans giant cellPhotomic showing tuberculous granuloma
  369. 369. Case #69310 year childTBc granulomaproximal tibia lookinglike chondroblastoma
  370. 370. Case #694 hip54 year female with tumoral calcinosis looking like chondrsarc
  371. 371. Sagittal T-1 MRI
  372. 372. Axial T-1 MRI
  373. 373. Amorphous calciumphosphate flowingfrom biopsy site
  374. 374. Resected specimen cut in path lab
  375. 375. Photomic showing heavy calcifcation
  376. 376. Case #694.1 Tumoril calcinosis 71 year female with tender lump over knee and forearm 1 yr
  377. 377. Case #69564 yr male with giant bone island looking like chondrosarc
  378. 378. CT scan
  379. 379. Case #696 AP x-ray hip 55 yr female with geode(DOA) looking like chondrosarc
  380. 380. Axial CT scan
  381. 381. Sagittal CT scan
  382. 382. Bone scan
  383. 383. Coronal T-1 MRI
  384. 384. Axial proton density MRI
  385. 385. Axial T-2 MRI
  386. 386. Case #696.1 Acetabular geode 44 year male with right hip pain for 1 year
  387. 387. Cor T-1 T-2 Gad
  388. 388. Axial T-1 T-2 Gad
  389. 389. Sag T-1 Gad
  390. 390. Case #69752 yr female with bone infarct looking like enchondroma
  391. 391. Sagittal T-1 MRIknee joint
  392. 392. Case #698 45 yr female with epiphyseal infarct looking like chondroblastoma
  393. 393. Case #69977 year femalerheumatoid arthritisshoulder looking likechondrosarcomaproximal humerus
  394. 394. Bone scan
  395. 395. CT scan
  396. 396. Another CT cut
  397. 397. Axial T-1 MRI
  398. 398. Axial T-1 MRI
  399. 399. Sagittal T-2 MRI
  400. 400. Coronal T-2 MRI
  401. 401. Resected proximalhumerus specimen

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