PMC5458704_01
Anteroposterior radiograph of the left thigh showing a proximal third diaphyseal lesion of the left femur. Note the aggressive features represented by the ill-defined margins with a wide zone of transition, cortical erosion and circumferential onion skin appearance denoting moderately aggressive periosteal reaction.
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F1
The initial radiographs of the left thigh showed a proximal third diaphyseal lesion of the left femur with aggressive appearance (Fig. 1).
Short tau inversion recovery-weighted coronal section of both thighs, showing hypersignal in the medullary canal at the left femoral diaphysis, with marked periosteal reaction and peripheral soft tissue hypersignal.
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F2
T1-weighted and hypersignal in fat-suppressed T2-weighted images, with medullary enhancement after contrast injection. There were areas of cortical disruption, extensive periosteal reaction and perilesional soft tissue edema, but no soft tissue invasion (Fig. 2 and 3).
T1-weighted axial section of both thighs, showing global muscular atrophy at the left, with cortical thickening of the left femur and abnormal hyposignal in the medullary canal. Some erosion is visible in the posterior cortex but without soft tissue invasion.
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F3
T1-weighted and hypersignal in fat-suppressed T2-weighted images, with medullary enhancement after contrast injection. There were areas of cortical disruption, extensive periosteal reaction and perilesional soft tissue edema, but no soft tissue invasion (Fig. 2 and 3).
Bone needle-biopsy initially performed. (a) Islands of newly-formed osteoid, alternating with areas of fibrosis (x10). (b) Fibrosis, with occasional lymphocytes (black arrows) and active osteoblasts (white arrows) surrounding newly-formed osteoid (x40).
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F4
Needle biopsy was performed 2 weeks after the initial presentation for microbiological and pathological evaluation, and no evidence was found for infection or tumor (Fig. 4).