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elbow and forearm, distal humerus

MSTS - ISOLS tumor quiz - case 3

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Case 3 A 59 year old woman with fatigue and a mass

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Myositis Ossificans

Myositis ossificans, (MO), otherwise known as heterotopic ossification, is an extra-osseous non neoplastic growth of new bone. Though the condition often accompanies bone trauma or complications, such as paralysis, it has also known to rarely present without injury or as an hereditary disorder.
Myositis ossificans circumscripta occurs in patients who have experienced trauma, especially in their arms or thighs. Certain hereditary abnormalities also cause MO.
MO presents as a rapid enlargement and significant pain in a muscle, one to two weeks after injury. Symptoms include swelling and warmth at the site as well as an increased ESR and serum alkaline phosphatase.Appearing two to four weeks after injury on film, the tumor presents with increasing calcification in the periphery towards the center, along with increased uptake.
treatment consists of making the correct diagnosis, avoiding the potential incorrect diagnosis of cancer or infection, supportive treatment for pain, and treatment designed to minimize the calcification of the muscle. There are unsubstantiated reports that medical marijuana is helpful for this disease.

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Quiste Óseo Aneurismático

El quiste óseo aneurismático (QOA) en una lesión solitaria, expansible y erosiva que afecta al hueso. Se encuentra frecuentemente dentro de la segunda década de vida y su ocurrencia es mayor en mujeres que en hombres (razón de 2:1). El QOA puede ser hallado en cualquier hueso del cuerpo. La localización más común es la metafísis de huesos largos, afectando las extremidades inferiores más que las superiores. Los arcos o cuerpos vertebrales de la espina dorsal pueden llegar a ser afectados. Aproximadamente la mitad de las lesiones en huesos planos ocurre en la pelvis. Una teoría sobre la etiología del QOA primario es que estas lesiones son secundarias a incrementos en la presión venosa que llega a causar hemorragia seguida por osteólisis. Esta osteólisis puede a su vez promover hemorragias adicionales causando amplificación del quiste.

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Tumor Mimics - Gout

Gout has been known to mimic many diseases since the time of Hippocrates. Destructive bone lesions from gout may present in an atypical patient, a teenaged patient, a patient with normal uric acid, or in an atypical location in the foot so that the clinician does not include gout in the differential. The association gout with the first metatarsophalangeal joint is so strong that a patient with gout in any other location as the risk of a delay in diagnosis even when the clinical picture is typical of gout. Gout can mimic both a soft tissue tumor or an aggressive bone lesion.

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