{"current_user":null,"case":{"id":74851,"title":"Carcinoma - tibia","url":"/cases/74851?lang=us","hidden_share_token":null,"image":"https://cdn.vetlucent.com/images/51978811/3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_thumb.jpeg","author":{"name":"Allison L Zwingenberger","profileUrl":"https://vetlucent.com/users/radvet?lang=us"},"presentation":{"text":"Presents for evaluation of a 2-3 month history of intermittent, progressive, left pelvic limb lameness.","age":"8 years","gender_name":"Spayed female","category_name":"Domestic dog","organism_name":"Airedale terrier"},"components":[{"case_id":74851,"id":85747,"type":"Study","questions":[{"stem":"Is this lesion aggressive or non-aggressive?","answer":"The pattern of permeative lysis indicates an aggressive lesion."},{"stem":"What categories of disease would you consider?","answer":"Neoplasia and infection are the two categories of disease that produce aggressive bone lesions."}],"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"findings":"\u003cp\u003eThere is moderate \u003ca href=\"#annotation-1273\" title=\"soft tissue swelling\" data-annotation-id=\"1273\"\u003esoft tissue swelling\u003c/a\u003e surrounding the lateral aspect of the proximal and mid diaphysis of the left tibia. Marked \u003ca href=\"#annotation-1269\" title=\"osteolysis\" data-annotation-id=\"1269\"\u003eosteolysis\u003c/a\u003e is affecting the cranial and lateral tibial cortices. In addition there is spicultated/reactive appearing \u003ca href=\"#annotation-1270\" title=\"new bone\" data-annotation-id=\"1270\"\u003enew bone\u003c/a\u003e production involving the cranial and lateral tibia. The margins of this lesion are somewhat indistinct with a \u003ca href=\"#annotation-1271\" title=\"long zone of transition\" data-annotation-id=\"1271\"\u003elong zone of transition\u003c/a\u003e. The cranial cortex appears discontinuous near the tibial crest. There is also a \u003ca href=\"#annotation-1272\" title=\"radiolucent\" data-annotation-id=\"1272\"\u003eradiolucent\u003c/a\u003e area in the lateral femoral condyle.\u003c/p\u003e\u003cp\u003e\n \u003cstrong\u003eImpression\u003c/strong\u003e\n\u003c/p\u003e\u003cp\u003eAggressive bone lesion, neoplastic or infectious inflammatory.\u003c/p\u003e","study":{"id":85747,"case_slug":"carcinoma-tibia","case_title":"Carcinoma - tibia","modality":"X-ray","series":[{"stack_root_id":51978811,"series_id":388745,"content_type":"image/jpeg","frames":[{"id":51978811,"current":true,"width":1632,"height":2112}],"annotations":[{"series_id":388745,"id":1270,"key_arrow_idx":0,"label":"new bone","label_positions":[{"slice_idx":0,"x":77,"y":1125}],"arrow_positions":[{"slice_idx":0,"rotation":-329,"x":434,"y":856},{"slice_idx":0,"rotation":-329,"x":549,"y":1026}]},{"series_id":388745,"id":1269,"key_arrow_idx":0,"label":"osteolysis","label_positions":[{"slice_idx":0,"x":77,"y":1391}],"arrow_positions":[{"slice_idx":0,"rotation":0,"x":581,"y":897},{"slice_idx":0,"rotation":0,"x":458,"y":822}]},{"series_id":388745,"id":1271,"key_arrow_idx":0,"label":"long zone of transition","label_positions":[{"slice_idx":0,"x":950,"y":894}],"arrow_positions":[{"slice_idx":0,"rotation":-134,"x":800,"y":998},{"slice_idx":0,"rotation":-134,"x":680,"y":861}]}],"pending_dicom_processing":false,"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"jumbo":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_jumbo.jpeg","big_gallery":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_big_gallery.jpeg","medium":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_medium.jpeg","gallery":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_gallery.jpeg","thumb":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_thumb.jpeg","small":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_small.jpeg","tiny":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224_tiny.jpeg","original":"3f5601a2c8d4e907e871361312ecb9c618d87081b42a94d54e169dcea5b38224.jpeg"}],"available_pipelines":["legacy","dicomrender"]},"perspective":"Lateral projection","specifics":null,"pipeline":null,"status":"ready"},{"stack_root_id":51978810,"series_id":388744,"content_type":"image/jpeg","frames":[{"id":51978810,"current":true,"width":784,"height":2336}],"annotations":[{"series_id":388744,"id":1272,"key_arrow_idx":0,"label":"radiolucent","label_positions":[{"slice_idx":0,"x":0,"y":1767}],"arrow_positions":[{"slice_idx":0,"rotation":0,"x":434,"y":618}]},{"series_id":388744,"id":1273,"key_arrow_idx":0,"label":"soft tissue swelling","label_positions":[{"slice_idx":0,"x":104,"y":68}],"arrow_positions":[{"slice_idx":0,"rotation":-434,"x":520,"y":1368},{"slice_idx":0,"rotation":-434,"x":551,"y":1078}]}],"pending_dicom_processing":false,"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"big_gallery":"4eeb62b0e792ac56a58195a1db54ea2e501cc8d6294a1daf23cb312d086d9406_big_gallery.jpeg","medium":"4eeb62b0e792ac56a58195a1db54ea2e501cc8d6294a1daf23cb312d086d9406_medium.jpeg","gallery":"4eeb62b0e792ac56a58195a1db54ea2e501cc8d6294a1daf23cb312d086d9406_gallery.jpeg","thumb":"4eeb62b0e792ac56a58195a1db54ea2e501cc8d6294a1daf23cb312d086d9406_thumb.jpeg","small":"4eeb62b0e792ac56a58195a1db54ea2e501cc8d6294a1daf23cb312d086d9406_small.jpeg","tiny":"4eeb62b0e792ac56a58195a1db54ea2e501cc8d6294a1daf23cb312d086d9406_tiny.jpeg","original":"4eeb62b0e792ac56a58195a1db54ea2e501cc8d6294a1daf23cb312d086d9406.jpeg"}],"available_pipelines":["legacy","dicomrender"]},"perspective":"Caudo-cranial projection","specifics":null,"pipeline":null,"status":"ready"}],"caption":"Tibia","findings":"\u003cp\u003eThere is moderate \u003ca href=\"#annotation-1273\" title=\"soft tissue swelling\" data-annotation-id=\"1273\" class=\"external\"\u003esoft tissue swelling\u003c/a\u003e surrounding the lateral aspect of the proximal and mid diaphysis of the left tibia. Marked \u003ca href=\"#annotation-1269\" title=\"osteolysis\" data-annotation-id=\"1269\" class=\"external\"\u003eosteolysis\u003c/a\u003e is affecting the cranial and lateral tibial cortices. In addition there is spicultated/reactive appearing \u003ca href=\"#annotation-1270\" title=\"new bone\" data-annotation-id=\"1270\" class=\"external\"\u003enew bone\u003c/a\u003e production involving the cranial and lateral tibia. The margins of this lesion are somewhat indistinct with a \u003ca href=\"#annotation-1271\" title=\"long zone of transition\" data-annotation-id=\"1271\" class=\"external\"\u003elong zone of transition\u003c/a\u003e. The cranial cortex appears discontinuous near the tibial crest. There is also a \u003ca href=\"#annotation-1272\" title=\"radiolucent\" data-annotation-id=\"1272\" class=\"external\"\u003eradiolucent\u003c/a\u003e area in the lateral femoral condyle.\u003c/p\u003e\u003cp\u003e\n \u003cstrong\u003eImpression\u003c/strong\u003e\n\u003c/p\u003e\u003cp\u003eAggressive bone lesion, neoplastic or infectious inflammatory.\u003c/p\u003e","contributor_login":"radvet","case_id":74851,"case_key_image_id":null,"case_featured_at":null},"component_id":222306,"url":"/cases/74851/studies/85747?lang=us"},{"case_id":74851,"type":"Discussion","body":"\u003cp\u003eThe limb was amputated, and histopathology with immunochemistry diagnosed a carcinoma. \u003c/p\u003e\u003cp\u003eBone is limited in how it responds to injury and disease states. In general, bone reacts by increasing in opacity (sclerosis), decreasing in opacity (osteopenia or osteolysis), and by producing new bone (periosteal proliferation). The pattern of bone production or resorption as well as location and distribution of bony lesions give clues about the underlying process causing the changes.\u003c/p\u003e\u003cp\u003ePatterns of periosteal reaction, from least to most aggressive, include smooth, laminar, amorphous, and sunburst. Any pattern of osteolysis may be associated with an aggressive lesion; less aggressive lesions tend to demonstrate geographic osteolysis, followed by \"moth-eaten,\" and finally more aggressive lesions often demonstrate permeative osteolysis.\u003c/p\u003e","component_id":222308,"id":67953,"url":"/cases/74851/discussion?lang=us"}],"related_articles":[]},"playlist":null,"quiz":{"has_previous":true}}