6. Physical examination
V/S : BT 36.9 C PR 80 /min
BP 120/90 mmHg RR 20 /min
GA : An old Thai woman, good consciousness,
well co-operated, normosthenic build, no pallor, no
jaundice
HEENT : No pale conjunctivae, anicteric sclerae
Lymph nodes : Can’t be palpated
7. Heart : Pulse full and regular, capillary refill < 2
second, normal S1S2, no murmur
Lung : Clear and equal breath sound both lungs
Abdomen : No distention, normoactive bowel
sound, soft,no tenderness, no guarding, no
hepatosplenomegaly
Physical examination
8. 5 cm round, smooth,
regular border, hard
consistency, not
movable, tender mass
at left lower quadrant
Physical examination
10. Problem list
1. A 65-year-old woman with 5cm tender, hard
consistency, not movable left hip mass for 2
months, 5 years of left hip pain and significant
weight loss
2. Underlying disease : DM, DLP, Hyperthyroidism
15. Osteosarcoma
• Production of osteoid from malignant
mesenchymal cell
• 2nd most common primary malignant tumor of
bone after multiple myeloma
• Most common radiation induce sarcoma
• Male > Female (except Parosteal osteosarcoma)
• Highest occurence : 10-20 years old
16. Osteosarcoma
• Most common site : Distal end of femur, proximal
end of tibia, head of humerus
• Metaphyseal(89%)>Diaphyseal(10%)>Epiphysea
l(1%)
• Hematogenous spread
• Most common metastatic site : Lung
• 5-year-survival rate : 68%
29. Prognosis
• 50% of high grade osteosarcoma - relapse in 5
months
• Sign of recurrence, mestastasis, treatment
related complication
• Recurrence - additional surgery;ampulation and
chemotherapy
• PE, radiograph of primary site, chest x-ray, bone
scan and laboratory examination
32. MRI OF PELVIS (18/03/2017)
FINDINGS:
There is infiltrative bone marrow lesion with mass forming in left iliac bone, measuring
6.0x4.5x6.7 cm (APxWxL).
Characteristics:
- Signal intensity: There is isointense on T1W, intermediate signal on T2W, restricted
diffusion, and heterogeneous enhancement.
- Uniformity: Heterogeneous.
- Fluid-Fluid Levels: None.
- Transition Zone: Narrow-edema.
Extent
- Neurovascular Involvement: None.
- Muscle Involvement: Mass involving left gluteus medius and biceps femoris muscles.
IMPRESSION:
Malignant bone tumor (6.0x4.5x6.7 cm) in left iliac bone involving left gluteus medius and
biceps femoris muscles. Differential diagnoses include bone metastasis and
chondrosarcoma.
Offer histologic diagnosis where possible.