Presentation
Presents for evaluation of a 2-3 month history of intermittent, progressive, left pelvic limb lameness.
Patient Data
There is moderate soft tissue swelling surrounding the lateral aspect of the proximal and mid diaphysis of the left tibia. Marked osteolysis is affecting the cranial and lateral tibial cortices. In addition there is spicultated/reactive appearing new bone production involving the cranial and lateral tibia. The margins of this lesion are somewhat indistinct with a long zone of transition. The cranial cortex appears discontinuous near the tibial crest. There is also a radiolucent area in the lateral femoral condyle.
Impression
Aggressive bone lesion, neoplastic or infectious inflammatory.
Case Discussion
The limb was amputated, and histopathology with immunochemistry diagnosed a carcinoma.
Bone 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.
Patterns 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.
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