Swelling Of Left Knee Research Articles

Osteomyelitis appearing as bone tumor: a case series

Introduction: Focal bone lesions are common and often found on routine radiology examinations. While many lesions are true neoplasms, several bone abnormalities are not tumors. It is essential for radiologists and clinicians to be aware of this possibility and to identify characteristic features that make it possible to differentiate between bone tumors and lesions that resemble bone tumors. This case series will specifically discuss osteomyelitis, which resembles a bone tumor Case Description: There were three cases with features of osteomyelitis that appeared as bone tumors. The first case is a 3-year-old girl with swelling in her right knee. The differential diagnosis based on X-ray examination are chondroblastoma and aneurysmal bone cyst. The second case is a 24-year-old man with left knee swelling. The differential diagnosis based on X-ray examination is chondroblastoma and giant cell tumor (GCT). The third case is a 45-year-old man with swelling and pain in his right thigh. The differential diagnosis based on X-ray examination is periosteal osteosarcoma. All three cases underwent laboratory examination and showed signs of infection, such as leucocytosis, elevated ESR, and elevated CRP. Histopathology examination of all cases shows chronic inflammation. Conclusion: On X-ray examination, it is difficult to differentiate between osteomyelitis and bone tumors. Cases of osteomyelitis that resemble bone tumors emphasize the importance of clinical history, laboratory examination, and radiography because they are generally difficult to detect.

E69 Localised intraarticular pigmented villonodular synovitis in an adolescent patient: a case-based review of the literature

Abstract Introduction Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive subtype of tenosynovial giant cell tumours that affect the synovium of the joints and tendons, occurring either focally or diffusely associated with the deposition of hemosiderin into the involved joint(s) and soft tissues. Although PVNS is historically considered an inflammatory process, recent evidence suggests the possibility of a neoplastic transformation. In addition, despite being typically found as a monoarticular knee disorder, other large and small joints can also be affected. The disease is rarely reported in African children, with most reported cases not histologically confirmed. We, therefore, present the first histologically proven case of localised intraarticular PVNS in an African teenager who presented with unilateral left knee swelling and pain. Method/Setting We report the case of a 16-year-old male teenager who presented to the rheumatology clinic with a nine-month history of non-traumatic anterior left knee swelling and pain that increased over time with associated difficulty walking and standing without aid. After clinical examination and relevant investigations, Magnetic Resonant Imaging (MRI) was done to confirm our suspicion of PVNS. Findings/Treatment Examination revealed a tender, swollen knee with a fluctuant palpable infrapatellar mass. Knee arthrocentesis yielded about 200mls of non-clotted hemorrhagic effusions. The patient had an open synovectomy following MRI, which was highly suggestive of pigmented villonodular synovitis with extensive suprapatellar bursitis. Specific histological findings (below) further confirmed the diagnosis. He commenced early physiotherapy, and symptoms resolved without recurrence of swelling eleven months after surgery. Conclusion This case highlights the visual presentation of an uncommon joint disorder and suggests it is considered a differential diagnosis of non-traumatic monoarticular pain and swelling in our rheumatology clinic set-up and among teenagers in whom juvenile rheumatoid arthritis would have been the first differential. Key words: Pigmented villonodular synovitis, Synovectomy, Multinucleated giant cells Contribution statement: AA conceived the idea to write the case report, draft the first manuscript, and manage the patient. YA, HO and AF edited the manuscript, while AIL interpreted the histological findings. All the authors approved the final version of the manuscript. Disclosure statement: None declared. Ethics and patient consent: This case report adheres to the Helsinki declaration, and the patient’s parents gave written consent to publish the details of the information. Additional information: Any institution did not fund this publication. Acknowledgements: We thank Dr Isaac Akanbi and Dr Bukar for interpreting the MRI and performing the surgery.

Extraskeletal Para-Articular Osteochondroma of Hoffa’s Fat Pad

Extraskeletal para-articular osteochondromas are rare benign intracapsular tumours. They occur due to osteocartilaginous metaplasia in the para-articular soft tissue in the elderly. We report the same in the knee in a young patient, arising from Hoffa’s fat pad. A 26-year-old male presented with a gradually enlarging anterior left knee swelling of 3-year duration and inability to flex the knee fully. Clinical and radiological evaluation detected an ossified mass in Hoffa’s fat pad with features of osteochondroma. He underwent an excision of the mass and histopathology confirmed the diagnosis of extraskeletal para-articular osteochondroma. He was asymptomatic with functional improvement at 5-month follow-up. Extraskeletal para-articular osteochondromas are slow-growing, benign extrasynovial tumours arising in soft tissues with rare occurrence. They can present even in young and can only be diagnosed with a high index of suspicion, radiological features and clinicopathological correlation. They have to be distinguished from synovial chondromatosis and chondrosarcoma. It can be treated by surgical excision without any recurrence. If left untreated may lead to patellar tendinopathy and functional limitations.

LATE-ONSET COMBINED IMMUNE DEFICIENCY IN A PATIENT WITH ADENOSINE DEAMINASE GENE MUTATION

<h3>Introduction</h3> We report on a 25-year-old man with a history of recurrent pneumonia and large joint infections who was found to have T cell dysfunction with B cell lymphopenia and a heterozygous adenosine deaminase(ADA) gene mutation. <h3>Case Description</h3> The patient has had three large joint infections and three-to-four episodes of pneumonia in his life. He is without other prior medical condition or family history of immune deficiency. He presented to the ER with tachycardia and left knee swelling. He was found to have pseudomonas bacteremia of unknown source for which he was treated. Due to his tachycardia, he had a chest CT to evaluate for pulmonary embolism which revealed found incidental bronchiectasis. Evaluation for immune deficiency was initiated and he was found to have IgA <10 mg/dL, IgG <75, and IgM <20, CD4 count 202 cells/uL, CD8 596, low response to polysaccharide and protein vaccines. HIV testing was negative. We then pursued genetic testing. Patient was found to carry a single pathogenic variant in the ADA gene. Loss of function variants in this gene are associated with severe combined immunodeficiency, but a second variant was not identified. Our patient is doing well on IVIG without further infections. <h3>Discussion</h3> To our knowledge, our patient is the first reported to be a carrier for a pathogenic ADA gene mutation and presenting with a clinical phenotype of B cell lymphopenia and T cell dysfunction. A more complete understanding of the underlying genetic causes for late-onset combined immune deficiency is needed as well as any correlation with ADA deficiency.

S3160 Sickle Hepatopathy: An Uncommon Sickle Cell Crisis

Introduction: Intrahepatic vaso-occlusive syndrome, or sickle cell hepatopathy (SCH), is a rare complication of sickle cell disease. We present a case of acute hepatic sequestration in the setting of bacteremia. Case Description/Methods: 32 male with history of sickle cell disease, auto-splenectomy and end stage renal disease presented with fatigue and diffuse myalgia. Physical exam was notable for scleral icterus, left knee swelling and erythema, and crackles in bilateral lungs. Initial labs showed leukocytosis (WBC 43,000/μL), profound anemia (Hgb 3.7 g/dL) and coagulopathy (INR 2.1). Liver enzymes were elevated at ALP 527 U/L, ALT 48 U/L, AST 209 U/L. Total bilirubin was 39 mg/dL with conjugated fraction 34.4 mg/dL, blood urea nitrogen 67mg/dL, creatinine of 4.34mg/dL, and ferritin >10,000. Blood cultures revealed Staphylococcus Aureus, likely due to left knee septic joint. US showed hepatomegaly with liver span of 24 cm. Clinical picture consistent with sepsis secondary to MSSA bacteremia in setting of sickle cell crisis and hepatopathy. Patient was admitted to ICU for hypoxic respiratory failure due to fluid overload. Clinical course was complicated by septic shock with multi-organ dysfunction including acute liver failure due to hepatic sequestration crisis, hemochromatosis, encephalopathy and disseminated intravascular coagulation. Patient required CRRT and supportive care including treatment of underlying infection, PRBC transfusions, and vitamin K administration to reverse coagulopathy (Figure). Discussion: Hepatopathy occurs in 10% of homozygous sickle cell patients. It can be self resolving or lead to fulminant hepatic failure. Subsets of SCH include Acute Hepatic Crisis(AHC), Hepatic Sequestration, Intrahepatic Cholestasis(IC). Sickling in the sinusoids leading to hepatocellular necrosis, engorgement of Kupffer cells and bile stasis. Common presentation of all three conditions includes acute RUQ pain, nausea, fever, and elevated liver enzymes. IC is severe presentation of SCH with hypoxic injury leading to blockage and cholestasis. Presentation overlaps with AHC with addition of hyperbilirubinemia, severe jaundice, renal impairment, and encephalopathy. Total bilirubin is typically markedly elevated due to combination of hemolysis, cholestasis and renal dysfunction. Sequestration presents with significant rapid onset hepatomegaly, drop in hemoglobin with RUQ pain, which can ultimately lead to cardiac and pulmonary instability. Treatment is supportive with exchange transfusion, fresh plasma for coagulopathy.Figure 1.: Top: Contrast enhanced spiral CT of the chest, abdomen and pelvis showing markedly enlarged measuring 20 cm in craniocaudal dimension with lobulated contour and non visualized spleen Bottom: Liver biopsy showing dilated sinusoids with aggregates of sickled red blood cells. There is also presence of canalicular cholestasis.

P152 African Woman With a Knee Knocked by a Rare Dematiaceous Fungi

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectives/IntroductionIncidence of fungal peri-prosthetic joint infection (PJI) is rare (1%-3%) and the majority are caused by Candida and Aspergillus. We report a peri-prosthetic knee joint infection caused by a rare dematiaceous fungi—pleurostomophora richardsiae, probably the first case in the world.Methods/Case DetailsA 78-year-old East African female from Malawi, housewife, with no known medical comorbidities presented with a chronic history of left knee pain and pus discharge. She had left knee pain since 2008 and was given several intra-articular injections between 2008 and 2010 for pain relief suspecting osteoarthritis. She denied a history of splinter injuries, trauma, systemic, or constitutional symptoms.In 2010 she underwent left total knee replacement (TKR) in the USA, but the pain persisted post-operatively associated with intermittent swelling of both knees. She was evaluated again in 2015 and revision left TKR done with single stage exchange.She was asymptomatic for a few years but symptoms worsened again and drainage of pus from her left knee started in December 2019. She was treated in Malawi with multiple courses of parenteral and oral antibiotics but did not improve.She presented to our hospital in January 2022 with swelling in left knee and restriction of movements. On examination, a discharging sinus was noted over the medial aspect of left knee. She was anemic with a normal leucocyte count, HIV negative, ESR of 85 mm/h, and CRP of 23 mg/L. Her renal and liver function tests were normal. CT left leg with sinogram showed features of chronic osteomyelitis of left distal femur and proximal tibia with active sinus tract in left tibia.Sinus tract excision with removal of prosthesis, debridement, and antibiotic cement spacer insertion was done. Bone and peri-prosthetic tissue were sent for histopathology and microbiological analysis including fungal and mycobacterial cultures. Xpert MTb was negative.Histopathology showed granulomatous synovitis with fungal hyphae and spores. Cultures grew a slender septate dark pigmented fungus, Pleurostomophora richardsiae which was confirmed by fungal PCR sequencing of internal transcribed spacer (ITS) region.Results/TreatmentShe was treated with Liposomal amphotericin B 5 mg/kg IV OD for 2 weeks followed by oral Itraconazole. She had persistent raised inflammatory markers at 4 weeks which settled after changing to posaconazole for 2 weeks. Conservative management will continue for 3-6 months with second stage revision arthroplasty/arthrodesis later.ConclusionDematiaceous fungi usually cause skin and soft tissue infections and they are extremely rare in causing prosthetic joint infection. Case reports of P. richardsiae causing osteomyelitis of foot and endocarditis are available but we couldn't find a published case of prosthetic joint infection caused by it. Identifying the causative organism in PJI is the most important step because the management depends mainly on it.Two-stage exchange in combination with antifungal administration between stages and post-revision should be the procedure of choice for fungal PJI. Incorporation of antifungal agents into cement spacers appears to be effective in eradicating local infections and reducing the duration of antifungal treatment and should be strongly considered.

Arthroscopic removal of multiple foreign bodies in the knee: A case report

We report the uncommon case of knee arthroscopic removal of multiple bullet pellets. A 25-year-old male professional footballer was admitted with left knee swelling, pain, and limitation of movement following a gunshot injury. Radiographs revealed multiple pellets in and around the left knee, each measuring about 5 mm in diameter. There were several pellets in the subcutaneous, intramuscular, and intra-articular parts of the left knee. The pellets were metallic, contraindicating magnetic resonance imaging to assess intra articular structures. He was booked for an urgent knee arthroscopy and the pellets were retrieved, and the other vital intra articular structures were examined. Three 5 mm diameter spherical bullet pellets were removed from the joint cavity. The synovial membrane was debrided, and the knee lavaged. Recovery was satisfactory with no complications. The patient was discharged to physiotherapy and followed up at 3 and 6 months after surgery. Foreign bodies in the knee are not uncommon; however, the presence of multiple bullet pellets is rare, especially in the index case of a sportsman. Its removal can be challenging, even arthroscopically. Such a procedure can result in severe complications, such as infections and joint deformities. The decision to use the arthroscopic approach requires careful deliberation regarding the status of the patient vis-a-vis the available skill and experience of the managing team.

Pasteurella multocida Endocarditis with Septic Arthritis: Case Report and Review of the Literature

Background: There is a paucity of evidence regarding optimal management of Pasteurella spp. endocarditis. The authors report the first case of Pasteurella spp. endocarditis with septic arthritis and review the literature. Case Description: A 79-year-old patient with significant comorbidities, including prosthetic aortic valve, was admitted with left knee swelling, fever, and confusion, having been scratched by a cat 2-weeks prior. At presentation, there was a metallic click, a Grade 3 pan-systolic murmur and Grade 1 flow murmur audible on auscultation. Blood and synovial fluid cultures both isolated Pasteurella multocida, identified by matrix-assisted laser desorption ionisation–time of flight, which was sensitive to penicillin according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST); minimum inhibitory concentration: 0.094). The patient underwent joint washout and received intravenous piperacillin/tazobactam for 3 days before switching to benzylpenicillin once sensitivities were known. Due to continued pyrexia, a transthoracic echocardiogram was obtained, which revealed a small mobile mass on a thickened mitral valve suspicious for a vegetation. On review by the Infective Endocarditis team, conservative management was deemed best, given the presence of comorbidities. Despite requiring further joint washout due to persistent knee pain, the patient was successfully treated with 8 weeks of antibiotic therapy (24 days of benzylpenicillin monotherapy, 2 weeks of benzylpenicillin and ciprofloxacin, and 15 days ciprofloxacin monotherapy). Discussion: Previous literature reviews report a higher mortality of Pasteurella spp. endocarditis when managed without cardiac surgery, thus recommending surgery in all cases. The authors found these to have confounding factors, including inadequate duration of antimicrobials, aortic root abscess, and rapid progression to death. The authors’ case of Pasteurella spp. endocarditis, complicated by septic arthritis, showed successful therapy without cardiac surgery.

Acute Knee Injury During Professional Basketball Tournament In A ‘Bubble’ Setting

HISTORY: A 30 year-old professional male basketball athlete experienced sharp left knee pain after planting extended leg with knee in slight flexion during an abrupt defensive movement in a game. He immediately fell down holding left knee due to intense pain. Pain was ‘relieved’ after knee was placed in extension, but reported knee feeling ‘weird’. Prior to injury, athlete reported history of left patellar tendinitis 2 years prior treated conservatively, lack of strengthening program for 4 months in 2020 due to COVID pandemic, intense pre-bubble preparations consisting of 2-a-day full court basketball sessions, and a strenuous game schedule during the ‘bubble’. Prior left knee X-Ray remarkable for Patella Alta. He was treated for right patellar tendinitis and adductor strain during the bubble. He also suffered a suspected left knee contusion in a game 3 days prior that was gradually improving towards the day of injury. PHYSICAL EXAMINATION: Anterior left knee swelling and indentation on initial inspection. No tenderness to palpation on anterior knee after physician placed knee in extension. Able to perform left knee flexion, but markedly limited knee extension and mobility during walking. Further Inspection revealed indentation in below patella with knee flexion. Quadriceps contraction revealed anterior tilting of inferior pole of patella. Unable to perform straight leg raise test due to difficulty lifting knee. Negative Lachman’s, Valgus and Varus Stress Tests. DIFFERENTIAL DIAGNOSIS: Patellar Tendon Rupture, Patellar Dislocation, ACL Tear. TEST AND RESULTS: Diagnostic Ultrasound remarkable for hypoechoic region at proximal patellar tendon at insertion suggestive of discontinuity of the tendon. MRI confirmed full thickness tear of patellar tendon. FINAL WORKING DIAGNOSIS: Left Patellar Tendon Tear TREATMENT AND OUTCOMES: Left knee initially placed in full extension with ‘medial’ pull of patella due to initial suspicion of patellar dislocation. Athlete then immobilized in full extension until follow up with Orthopaedic Surgeon. Underwent left patellar tendon repair within 1 week of injury. Acute rehabilitation course consisted of immobilization of brace at 30 degrees with gradual range of motion exercises, light quadriceps strengthening and pain management modalities.

S2237 Lyme Arthritis Mimicking Inflammatory Bowel Disease-Associated Arthritis in Patient With Crohn’s Disease

INTRODUCTION: Arthritis is a recognized extraintestinal manifestation of inflammatory bowel disease (IBD) with 6 to 46 % prevalence. It should be suspected in patients with IBD who develop joint pain, stiffness, or symptoms of inflammatory back pain. Here we describe a case of inflammatory polyarthritis in a patient with Crohn’s disease that was nonresponsive to conventional IBD treatment, later diagnosed with Lyme arthritis. CASE DESCRIPTION/METHODS: A 34 Y old man with 2-year history of ileocecal Crohn’s disease on Infliximab in clinical remission was seen for 6-month history of migratory joint pain involving multiple joints including bilateral hips, knee and ankle. CBC, ESR and fecal calprotectin were within normal limits. CRP was mildly elevated (20 mg/L, N < 10 mg/L). On examination there was joint tenderness without joint swelling. He was started on sulfasalazine 500 mg TID which was gradually increased to 1000 mg TID. This resulted with minimal improvement in joint pain. Infliximab was switched to adalimumab due to refractory joint pain. He presented 2 months later with acute swelling of left knee. Arthrocentesis was performed and synovial fluid analysis showed WBC 24,000 cells/ml and positive PCR for B. burgdorferi DNA. He was started on oral doxycycline resulting in gradual improvement in joint pain. DISCUSSION: The arthritis associated with IBD may manifest primarily with axial or peripheral joint involvement. Arthritis is usually non erosive and self-limiting. Episodes of exacerbations and remissions of synovitis may continue for years. This considerably overlaps symptoms of Lyme arthritis which includes intermittent or persistent attacks of joint swelling and pain during a period of months to several years, with few systemic manifestations. Arthritis can begin 4 days to 2 years (mean, 6 months) after the tick bite. In our case, arthritis was resistant to sulfasalazine and 2nd anti TNF. It was only after development of joint swelling, an arthrocentesis revealed diagnosis of Lyme’s disease. It is crucial to explore other causes of arthritis in patients with IBD, especially after failure to respond to initial treatment. Treatment of IBD associated arthritis includes addition of either sulfasalazine, methotrexate, azathioprine or 6-mercaptopurine. In resistant cases, TNF-alpha inhibitor can be initiated or switched to a second TNF inhibitor before trying another biologic agent, while Lyme’s arthritis is treated with antibiotics.

Primary patellar osteomyelitis presenting as a pre-patellar bursitis in children: a potential diagnostic mistake

&lt;p class="abstract"&gt;A 14-year-old male presented with pain and swelling of left knee since 15 days with history of non-significant trauma and mild fever. On clinical examination there was raised superficial skin temperature and pre-patellar effusion with positive patellar tap. Haematological investigations show moderate leucocytosis and raised acute phase reactants, with an unremarkable radiography. Under the impression of infective pre-patellar bursitis, patient was posted for arthrotomy, debridement and wound wash. Post-operative broad spectrum antibiotics started. 2 weeks after surgery the swelling reappears, when an advanced imaging was offered which shows osteomyelitic changes in upper pole of patella. After 6 weeks of intravenous antibiotics and conservative management, the lesion was healed leaving no sequel.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

An unusual case of bleeding in a patient with a positive lupus anticoagulant

A 3½ year old girl presented with bruising, left knee swelling and an episode of epistaxis. One week prior to admission she had confirmed adenovirus gastroenteritis. Examination revealed bruising, a small left knee haemarthrosis and an urticarial reaction to adhesive dressings.

Arthroscopic retrieval of a large foreign body: A case report and literature review

Background: We report the removal of a large metallic foreign body and review the relevant literature. Methods: A 28 y old woman was admitted with left knee swelling, pain, and limitation of activity resulting from an accident 7 d earlier. Radiography revealed a 3 × 1 cm foreign body at the mid-tibial plateau. As the foreign body may have been metallic, it was not possible to perform magnetic resonance imaging to determine whether damage to the cruciate ligaments was present. Finally, the foreign body was retrieved. Results: A 3 × 4 × 5 cm triangular broken knife blade was removed from the joint cavity. We excised the lateral meniscus, which had been damaged by the foreign body, and debrided the hyperplastic synovial membrane. Recovery was favorable with no complications. The patient was followed up at 6 months after surgery. Conclusions: While foreign bodies in the knee are not uncommon, the presence of a large object is rare. When foreign bodies are small, most can be removed arthroscopically with a minimum of difficulty. In contrast, large foreign bodies within the knee joint cavity require an incision to open the joint for adequate exposure and removal of the object. Such a procedure can result in severe complications, such as infections and joint deformities. The decision to use one or the other approach requires careful consideration regarding the condition of the patient along with the skill, knowledge, and experience of the health care team.

Patella gigantism following traditional bonesetter treatment

The patella is the largest human sesamoid bone, lies within, and is an important component of the knee extensor mechanism. Tumors and tumor-like lesions of the patella are rare. Fractures of the patella are relatively uncommon and account for 1% of all musculoskeletal system fractures. These fractures can be managed by traditional bonesetters with attendant complications. To report a case of patella gigantism following a patella fracture which was treated by a traditional bonesetter. An 18-year-old male Nigerian presented with a 2-year history of anterior left knee swelling following a motorcycle accident. A diagnosis of closed patella fracture was made, but he declined orthodox treatment. Treatment had been from traditional bonesetters who were massaging the knee regularly for about 2 years. Clinical and radiographic examinations revealed an enlarged patella. He had patellectomy and reconstruction of the extensor mechanism of the left knee. The patella measured 22 cm × 18 cm and weighed 0.5 kg, which was regarded as a giant patella. Histopathological report of the excised patella revealed patella sclerosis. He made an uneventful recovery and presently walks about unaided. Patella gigantism can occur following treatment of patella fracture by traditional bonesetters. We recommend patellectomy and reconstruction of the extensor mechanism, whenever a giant patella is encountered.

PTEN hamartoma of the soft tissue: the initial manifestation of an underlying PTEN hamartoma tumor syndrome in a 4-year-old female

A 4-year-old female was referred to pediatric orthopedic surgery for left leg pain and limping for 3 months following a motor vehicle collision. Recently, the patient's mother had noted left knee swelling and dragging of the left leg when walking. Past medical history was significant for hip dysplasia with slight leg length discrepancy. The patient was otherwise healthy. Physical examination was remarkable for left pre-patellar soft tissue fullness with normal range of motion. There was no warmth or tenderness. Subsequent ultrasound revealed a heterogeneous soft tissue mass superior and medial to the patella with a moderate degree of internal vascularity. MR exhibited a heterogeneous soft tissue mass with heterogeneous signal on both T1- and T2-weighted images centered within the vastus medialis obliquus muscle infiltrating the quadriceps tendon. Excisional biopsy was performed with a histopathologic diagnosis of fibroadipose tissue with anomalous vessels, suggestive of phosphatase and tensin homolog (PTEN) hamartoma of the soft tissue (PHOST). The patient was found to be positive for the PTEN gene mutation on genetic testing. The child was also determined to be macrocephalic, a major criterion for PTEN hamartoma tumor syndrome (PHTS). The geneticist advised the patient to undergo yearly physical examinations and early, routine surveillance for several malignancies occurring with PHTS. This case report presents the ultrasound and MRI appearance of a rare benign tumor typically appearing in pediatric patients. The strong association between PHOST and other soft tissue malignancies and the resulting need for life-long surveillance make PHOST an important pathology to recognize.

Primary bone lymphoma of radius and tibia

Rationale:Primary bone lymphoma (PBL) is a rare malignant entity. There is a better survival of PBL than any other malignant bone tumors and extranodal lymphomas.Patient concerns:We report a rare case of PBL involving radius and tibia. The patient was a 14-year-old girl with left forearm pain and swelling after trauma. Six months later after the last chemotherapy and radiotherapy, pain and swelling of left knee was presented.Diagnoses:Radiological imaging revealed a lytic destruction, periosteal reaction, and pathological fracture of radius and tibia with soft tissue mass. Surgical biopsy was performed, and the result of histopathological diagnosis was diffused large B-cell lymphoma (stage IV, group A).Intervention:Chemotherapy combined with radiotherapy was applied before curation.Lessons:Due to its uncommon presentation, PBL should be taken into consideration if differential diagnosis from other bone tumors is necessary in clinic.

Myofibroblastic sarcoma in a sickle cell anemia patient: A case report from Sokoto, North-Western, Nigeria

Low-grade myofibroblastic sarcoma (LGMS) is a rare malignant tumor of soft tissue that commonly presents as a painless enlarging mass of the affected site. There are several reported cases of malignant cancers among sickle cell disease (SCD) patients, and to the best of our knowledge, there was no previously reported case of LGMS occurring in a known SCD patient in our environment. We report a 16-year- old patient with sickle cell anemia who presented with the left knee swelling that was initially managed as a benign infection, but a later histological examination revealed a diagnosis of LGMS.

Joint Sonography in Patient with Hematoidin Crystals in a Clinically Suspected Septic Arthritis

Hematoidin is an erythrocyte derived product without containing iron. It is rare to find intracellular and extracellular hematoidin crystals in joint effusion. Sonographic description was never described before. We present a case of monoarthritis in a patient with alcoholic cirrhosis and compare his sonographic findings with CT scan and MRI and pathologic findings. Case report and literature review. This 40 year-old man, Taiwanese aboriginal Atayal, with alcoholic liver cirrhosis and diabetes mellitus presented with left knee swelling of acute onset for 1 week. CT scan at emergency room showed free air within the joint effusion Ultrasound was performed and showed heteroechoic thickening of the synovium with focal hyperemia and hyperechoic lines suggesting free air in the synovium. There was also superficial enhancement of the articular cartilage layer. MRI of the knee showed no nodular proliferation of the synovium with lobulated margins or blooming artefact on gradient echo suggesting pigmented villonodular synovitis. Joint aspiration and synovial fluid analysis revealed the presence of intracellular and extracellular hematoidin which is a yellow, rhomboid plate. Joint bacterial culture was negative. He received joint synovectomy and no micro-organism was identified. Pathology showed focal necrosis with acute and chronic inflammatory cells in the synovium. Hematoidin is a soluble crystal which is seldom present in the synovial fluid. Previous report also showed that hematoidin is present in patients with staphylococcus aureus septic arthritis preceded by previous repeated previous repeated traumatic injuries. Here we presented the sonographic findings of a joint inflamed by the presence of hematoidin crystals.

A rare case of osteochondroma of Patella-Case Report

Tumors involving the patella are very rare. Only a few studies have been reported. The commonest benign tumor involving the patella is giant cell tumor. We in our study report a case of osteochondroma involving the patella. A 23 year old male patient presented with swelling of left knee of ten year duration. Radiology showed an ill-defined bony mass attached to the patella. We had done an excision of the lesion. The histopathological report was osteochondroma. Two cases reports from Medline have reported about osteochondroma involving patella (9, 10). The case is reported for the rarity of presentation.

Monophasic synovial sarcoma: a case report and literature review

Synovial sarcoma is an aggressive soft tissue tumor which accounts for 7% - 8% of all human malignant sarcomas. Although this tumor generally affects adults, about 30% of reported cases occur in children and adolescents. Synovial sarcoma is the most common malignant non-rhabdomyosarcomatous soft tissue sarcoma in children and adolescents. We report a case of synovial sarcoma presented with pain and swelling in the left knee. MRI of left knee shows 25×54×56 mm soft tissue lesion in infrapatellar bursa. FNAC left knee swelling reported malignant spindle cell tumor. The mass was completely resected in a surgical procedure. In pathological examination of the mass, monomorphic fibroblastic synovial sarcoma was reported. Patient was treated with Ifosfamide and Adriamycin.