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Presented by Edward McCarthy, M.D. and prepared by Shien Micchelli, M.D.
Case 3: A 60-year-old man had pain in his hip for two years.
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1. Question
Week 278: Case 3
A 60-year-old man had pain in his hip for two years. He had a history of prostate cancer treated by radical prostatectomy. Radiographs demonstrated a large lytic lesion in the ilium adjacent to the hip joint. There was also mild osteoarthritis of the hip. A serum PSA was zero.images/8_7_06_3a.jpg
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images/8_7_06_3d.jpgCorrect
Answer: Giant osteoarthritic cyst
Histology: This patient shows radiographically changes consistent with osteoarthritis. The large subchondral defect in the proximal tibia should be considered radiographically to be a very osteoarthritic cyst. Histologically, the lesion shows fibrous tissue with focal mucoid change. The mucoid areas coalesce to form a cavity with a fibrous lining.
Discussion: A giant cell tumor may show identical radiographic appearance. The giant cell tumor characteristically involves the epiphysis and metaphysis of long bones in skeletally mature patients. The presence of osteoarthritis in this case should highly raise the suspicion that this may be an osteoathritic cyst. The histology shows no giant cells. The differential is primarily a radiologic one.
Metastatic carcinoma should be top on the list for any older adult with a lytic bone lesion especially with a history of prostate cancer. However, there is no histologic evidence of epithileal cells in this tissue. In the event of any suspicion, keratin stains should be performed. The negative PSA whould make metastatic prostate cancer highly unusual.
Incorrect
Answer: Giant osteoarthritic cyst
Histology: This patient shows radiographically changes consistent with osteoarthritis. The large subchondral defect in the proximal tibia should be considered radiographically to be a very osteoarthritic cyst. Histologically, the lesion shows fibrous tissue with focal mucoid change. The mucoid areas coalesce to form a cavity with a fibrous lining.
Discussion: A giant cell tumor may show identical radiographic appearance. The giant cell tumor characteristically involves the epiphysis and metaphysis of long bones in skeletally mature patients. The presence of osteoarthritis in this case should highly raise the suspicion that this may be an osteoathritic cyst. The histology shows no giant cells. The differential is primarily a radiologic one.
Metastatic carcinoma should be top on the list for any older adult with a lytic bone lesion especially with a history of prostate cancer. However, there is no histologic evidence of epithileal cells in this tissue. In the event of any suspicion, keratin stains should be performed. The negative PSA whould make metastatic prostate cancer highly unusual.
