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| IMAGES IN MEDICINE |
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| Year : 2017 | Volume
: 14
| Issue : 4 | Page : 238-239 |
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Painful knee swelling in a 32-year-old Female
Raju Vaishya, Vipul Vijay, Amit Kumar Agarwal
Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| Date of Web Publication | 5-Feb-2018 |
Correspondence Address:
Raju Vaishya
Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi - 110 067
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/am.am_52_17
We discuss the presentation of an expansile lytic lesion in the distal femur of a young female. We also discuss the radiological findings of the lesion along with the possible differential diagnoses. The presence of such an expansile lytic lesion in a young adult raises multiple diagnostic possibilities, and the final decision depends on incisional biopsy.
Keywords: Femur, giant cell tumor, lytic lesion
How to cite this article:
Vaishya R, Vijay V, Agarwal AK. Painful knee swelling in a 32-year-old Female. Apollo Med 2017;14:238-9 |
| Case History | |  |
A 32-year-old female presented with pain in the right knee of 6-month duration. The pain was insidious in onset, dull aching in character, and nonradiating. There was no history of trauma to the knee. The pain was initially managed with oral analgesics, but the pain did not get relieved. The swelling was tender and bony hard on palpation with no soft tissue component. The knee range of motion was terminally painful in flexion. The patient underwent anteroposterior and lateral radiograph of the knee [Figure 1]. After the radiograph, magnetic resonance imaging (MRI) of the right knee was also ordered [Figure 2] and [Figure 3]. | Figure 1: Anteroposterior and lateral radiographs of the right femur showing the lytic lesion in the lateral femoral condyle
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 | Figure 2: Axial sections of the magnetic resonance imaging depicting the lesion as a cavity with fluid in it with some soft tissue component of the lesion as well
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 | Figure 3: Coronal sections of the magnetic resonance imaging of the knee showing the lesion as bright in T2-weighted images. Note that the subchondral bone is thinned out, but there is no breach in the cortex
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What is the interpretation of the images? What is your differential diagnosis?
The plain radiograph revealed an eccentric expansile lytic lesion in the epi-metaphyseal region of the lateral femoral condyle with completely thinned out cortices. The margins of the lesion were not sclerotic. There was no breach in the cortex although the lesion was just adjacent to the cartilage.
MRI revealed a large lesion filled with multiple septations in the lytic lesion along with soft tissue component. The content of the cavity was bright on T2-weighted image suggestive of fluid in the cavity, possibly blood. Along with the fluid, there was some intraosseous soft tissue component of the lesion as well.
What are the differential diagnoses on the basis of the clinicoradiological picture?
The presence of an eccentric lytic lesion in the epi-metaphyseal region of a bone in a 32-year-old female can have multiple differentials. The most common differential of such a lesion is giant cell tumor. These are common tumors with an incidence of 18%–23% and typically involve the epiphysis extending to the metaphysis.[1] Giant cell tumors are locally aggressive tumors of the bone, which usually occur due to the overexpression of the osteoclasts. They have a recurrence rate of 2.5%–10% with extended curettage.[1] Aneurysmal bone cyst is another differential of the lesion but can be differentiated to slightly younger age of presentation and presence of fluid–fluid levels in the lesion.[2] Brown tumors due to hyperparathyroidism can also present in a similar way but can be differentiated on the basis of the involvement of other sites as well-deranged blood parameters (such as parathyroid hormone and Vitamin D).[3] Other rare differentials of such lesions in this age group can be metastases, intraosseous ganglion cysts.
| Diagnosis | | |
The histopathology of the lesion sent during extended curettage and grafting revealed a giant cell tumor superimposed on a background of aneurysmal bone cyst.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ, et al. From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: Radiologic-pathologic correlation. Radiographics 2001;21:1283-309.  |
| 2. | Fritzsche H, Schaser KD, Hofbauer C. Benign tumours and tumour-like lesions of the bone: General treatment principles. Orthopade 2017;46:484-97. [ PUBMED] |
| 3. | Vaishya R, Agarwal AK, Singh H, Vijay V. Multiple 'brown tumors' masquerading as metastatic bone disease. Cureus 2015;7:e431. [ PUBMED] |
[Figure 1], [Figure 2], [Figure 3]
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