PMC538289_01
Radiograph of the pelvis showing a well-circumscribed osteolytic lesion in the left iliac bone; it is sharply marginated with a thin sclerotic rim and without any matrix calcifications.
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F1
A radiographic image of the pelvis revealed a large osteolytic lesion in the left iliac wing, sharply contoured with sclerotic margins, indicating a slow growth pattern (Figure 1).
a-d: MRI shows a mass originating from the ileum and extending into the soft tissues both anteromedially and posterolaterally. In T1-weighted sequences the mass is isointense with muscle (a). It enhances after administration of gadolinium (b, c). In fat-suppressed T2-weighted sequences it has high signal intensity (d).
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F2
MR-imaging of the pelvis showed a mass originating from the os ilium with a large extra- and intrapelvic soft-tissue component (Figure 2).
Defect after tumor resection, with disruption of the linea terminalis.
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F3
In accordance to the imaging results, the iliac crest could be preserved, while the linea terminalis of the left side had to be resected (Figure 3).
Macroscopic view of the resection specimen in transverse orientation. Large yellow osteodestructive tumor originating from iliac bone and with extensive extraosseous parts. Invasion of massa lateralis of sacral bone. Sharp borders between tumor and bone are indicative of a slow-growing neoplasm.
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Figure 4 shows the resected tumor specimen.
Histology of the resection specimen. Spindle tumor cells admixed with some multinucleated giant cells (left) and foamy macrophages (middle) and cholesterol clefts (right). (Hematoxyllin and Eosin x)
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Histological study of the resected specimen confirmed the diagnosis of BFH (Figure 5).
Status after interposition of the fibula transplant
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The pelvic ring was then stabilized in a second operation using a non-vascularized fibular autograft that was impacted and stabilized with screws and a Kirschner-wire reconstructing the linea terminalis of the left pelvic ring (Figure 6).
Radiographic check 18 months after surgery, showing identical position of the fibular transplant
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Radiographic and MRI controls at 3, 6 and 12 months postoperatively showed no evidence of local recurrence or secondary dislocation of the reconstruction (Figure 7).