PMC9922857_01
PMC9922857_02
Radiograph images, 3D reconstruction image, CT scan images and MRI images of the hip joint revealing massive osteolysis in the right femoral head, femoral neck, and acetabulum. Anteroposterior (A) and lateral (B) radiographs of the hip joint show massive osteolysis in the right femoral head, femoral neck, and acetabulum. The 3D reconstruction image (C), coronal (D), and horizontal (E) CT scan images confirm the complete disappearance of the right femoral head and destruction of the femoral neck and acetabulum. Coronal (F) and horizontal (H) T1-weighted images show extensive hypointense osteolytic lesions involving the right femoral head, femoral neck, and acetabulum. Coronal (G) and horizontal (I) fat-suppressed T2-weighted images indicate extensive hyperintensity osteolytic lesions.
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F1
Preliminary anteroposterior (Figure 1A) and lateral (Figure 1B) radiograph examinations of the right hip joint indicated that the femoral head had disappeared and that the margins of the femoral neck and acetabulum were incomplete, which were further confirmed by 3D reconstruction images (Figure 1C) and CT scan images (Figures 1D,E).
ECT with 99mTc-methylene diphosphate indicates increased focal concentrations of radiotracers in the right femoral head, femoral neck and, acetabulum.
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F2
T2-weighted images, and massive joint effusion in the right hip joint. To further clarify the progression of the disease, ECT examination (Figure 2) was performed and the results showed increased focal concentrations of radiotracers in the right femoral head, femoral neck, and acetabulum. Therefore, we highly suspected that this patient may be diagnosed with a malignant bone tumor with aggressive osteolytic lesions.
Histopathological examination of a biopsy in the right femur reveals small fragments of destroyed trabeculae with osteoclasts and proliferating thin-walled blood vessels.
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F3
Subsequent histological examinations showed that the necrotic bone tissue was accompanied by focal aggregation of osteoclasts, giant cells and plasma cells without cellular atypia, some proliferative thin-walled capillaries and lymphatic structures, and replaced by fibrous connective tissue (Figure 3).
Anteroposterior (A) and lateral (B) radiographs of the hip joint 3 years after total hip arthroplasty surgery.
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F4
Moreover, no signs of recurrence were observed in the right hip joint (Figure 4).