PMC7452413_01
Plain X-ray AP view showing lesion in distal fibula shaft region.
gr1.jpg
PMC7452413_01_gr1.jpg
fig0005
Plain radiograph of the right leg showed an intracortical lytic bony lesion with adjacent sclerosis but no cortical breach in fibula shaft region (Figs. 1 & 2).
Plain X-ray Lateral view showing lesion in distal fibula shaft region.
gr2.jpg
PMC7452413_01_gr2.jpg
fig0010
Plain radiograph of the right leg showed an intracortical lytic bony lesion with adjacent sclerosis but no cortical breach in fibula shaft region (Figs. 1 & 2).
Axial section of MRI showing the lesion.
gr3.jpg
PMC7452413_01_gr3.jpg
fig0015
MRI right leg (Figs. 3 & 4) confirmed an intramedullary diaphyseal lesion in fibula shaft, 6.2 cm away from ankle joint, with associated marked thinning of overlying cortex with focal cortical breech along anterior cortex. (suggestive of ewings sarcoma with osteosarcoma kept as another possibility).
Sagittal section of MRI showing the lesion.
gr4.jpg
PMC7452413_01_gr4.jpg
fig0020
MRI right leg (Figs. 3 & 4) confirmed an intramedullary diaphyseal lesion in fibula shaft, 6.2 cm away from ankle joint, with associated marked thinning of overlying cortex with focal cortical breech along anterior cortex. (suggestive of ewings sarcoma with osteosarcoma kept as another possibility).
Histopathology slide showing epitheloid granulomas, langhans giant cells.
gr5.jpg
PMC7452413_01_gr5.jpg
fig0025
Needle biopsy was done which on histopathology showed (Fig. 5) epitheloid cell granulomas, occasional langhans giant cells and moderate mixed inflammatory infiltrate.
X-ray after 12 months of anti-tuberculosis treatment showing healed lesion in distal shaft fibula region.
gr6.jpg
PMC7452413_01_gr6.jpg
fig0030
Currently patient is on anti- tuberculosis treatment (ATT) for past 12 months and reports alleviation of clinical symptoms with healed lesion on plain x-ray radiograph of right fibula taken at 12 months (Fig. 6).