Quiz-summary
0 of 1 questions completed
Questions:
- 1
Information
Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 3: A 20-year old man had pain in his ankle for 2 months. The pain was worse with activity.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
- Not categorized 0%
- 1
- Answered
- Review
-
Question 1 of 1
1. Question
Week 257: Case 3
A 20-year old man had pain in his ankle for 2 months. The pain was worse with activity. A radiograph demonstrated a fuzzy area of radiodensity in his distal tibia associated with a periosteal reaction.images/feb 2006 case 3 1.jpg
images/feb 2006 case 3 2.jpg
images/feb 2006 case 3 3.jpg
images/feb 2006 case 3 4.jpgCorrect
Answer: Stress fracture
Histology: none provided
Discussion: Histologically a stress fracture showed typical characteristics of a fracture callus with granulation tissue, new bone formation, and hyaline cartilage that is undergoing endochondrial ossification. Examination of multiple tissues will show a zonal pattern. Stress fractures are frequently misdiagnosed as more ominous lesions. A key feature in the clinical history is that of pain on activity.
The lesion is not an osteosarcoma. Osteosarcomas have a very cellular pleomorphic stroma with abnormal mitotic figures. Although the callous of the stress fracture can be cellular and show mitosis, abnormal mitoses are never present.
The lesion is not an osteoid osteoma. Stress fractures may indeed be confused with osteoid osteomas if they have been chronic. The intense periosteal reaction can mimic that seen in osteoid osteoma. A CT scan is often necessary to find a nidus of osteoid osteoma. This case does not show discreet nidus with benign osteoblasts producing neoplastic osteoid.
Incorrect
Answer: Stress fracture
Histology: none provided
Discussion: Histologically a stress fracture showed typical characteristics of a fracture callus with granulation tissue, new bone formation, and hyaline cartilage that is undergoing endochondrial ossification. Examination of multiple tissues will show a zonal pattern. Stress fractures are frequently misdiagnosed as more ominous lesions. A key feature in the clinical history is that of pain on activity.
The lesion is not an osteosarcoma. Osteosarcomas have a very cellular pleomorphic stroma with abnormal mitotic figures. Although the callous of the stress fracture can be cellular and show mitosis, abnormal mitoses are never present.
The lesion is not an osteoid osteoma. Stress fractures may indeed be confused with osteoid osteomas if they have been chronic. The intense periosteal reaction can mimic that seen in osteoid osteoma. A CT scan is often necessary to find a nidus of osteoid osteoma. This case does not show discreet nidus with benign osteoblasts producing neoplastic osteoid.
