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"Osteosarcoma"- Case Presentation
A 18-year-old woman presented with 3 months of left knee pain and swelling, and inability to walk for 1 month. Examination found a large, hard, fixed swelling above the left knee with deformity and muscle wasting. X-ray and CT scan showed extensive bone destruction in the left femur and tibia with lung metastases. Biopsy confirmed osteosarcoma.
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"Osteosarcoma"- Case Presentation
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- 2. Presenting By- Dr. Golam Muhamud (Suhash). Prepared By- Dr. Md Nazrul Islam MBBS, M .sc. (B M E).
- 7. • She hash/o wt. loss, and loss of appetite but she has /had no complaints of pain, swelling and deformity in other parts of the body. She has no history of cough , haemoptysis, DM , HTN and asthma. • With these complaints she got herself admitted into Shaheed Suhrawardy Medical college Hospital for better management.
- 8. She hadno history of tuberculosis. Drug history: • H/O taking analgesic for 3 months but could not mentioned the name of drugs.
- 9. None of herfamily member suffered from such illness. Personal history: Nothing contributory
- 10. • MP-4 to6 days • MC-regular • Age of menarche-13yrs.
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- 12. • Appearance- Ill looking • Body builds- Below average • Co-operation- Co-operated • Decubitus- Supine • Anaemia- Moderate • Jaundice- Absent • Cyanosis- Absent • Clubbing- Absent • Koilonychia-Absent • Lekonychia- Absent • Lymph nodes- Not palpable • Dehydration- No sign • Pulse - 84 Beat/min • Blood pressure- 100/60mm of Hg • Temperature-normal • Respiratory rate-16/min
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- 15. Fluctuation test- negative, Trans-illuminationtest-negative, Patellar tap test- negative. Shortening of limb - 3 cm. Muscle wasting- Thigh – 4 cm. Leg – 2 cm Distal neurovascular status- normal Regional lympnodesnot enlarged.
- 16. Movement: walk withsupport. Left knee (ROM)– • Active flexion -Absent • Active extension-Absent • Patellar movement-Absent Left hip & ankle: normal range of movement
- 17. Locomotor system Gait: Canwalk with support Inspection:Flexion attitude- Left knee(20 degree) Palpation: Tenderness – affected area. Spine: Normal
- 18. Higher psychic function:Normal Cranial Nerve examination: Normal Motor function: Inspection: Gross Muscle wasting in left thigh & leg.
- 21. Deep tendon reflex: All jerks are present & normal Sensory function test: All the sensory functions are normal.
- 22. Inspection: Normalin size & shape of the chest- Respiratory rate: 16 /min Palpation: Trachea centrally placed, normal chest expansibility Percussion: Resonant all over the chest except right upper, middle and lower zone where dullness is present. Auscultation: Bronchial breathing sound with diminished breathing sound in Rt. Upper middle and lower zone.
- 23. Pulse: 84bts/ min B.P. 110/60 mm of Hg JVP: Not raised. Inspection: NAD Palpation: Apex beat in Lt 5thintercostal space, Percussion: superficial cardiac dullness presence over the precordium. Auscultation: s1& s2 is audible
- 24. • Inspection: nothingabnormality detected • Palpation: soft, non tender • Percussion: tympanic Auscultation: bowel sound present Per-rectal examination: normal findings.
- 25. Ms. Fatema, 18years ill-looking, moderately anaemic, non icteric, nondiabetic, normotensive woman coming from Mirpur, Dhaka admitted in ShaheedSuhrawardy Medical College Hospital with thecomplaints of – • pain, just above the left knee joint 3 months back , • swelling above the left knee joint 2 months back and • inability to walk for 1month.
- 26. • The painwas initially mild , fixed, non radiating, aching in nature but gradually it becomes intolerable which was aggravated during walking and worse at night & incompletely relived by taking NSAIDs.Thispain was not associated with fever. • She also noticed an ill defined swelling above left knee joint which was initially.
- 27. Small in sizethen it increases rapidly to a large size.It is associated with pain but not related to trauma. • She also gives H/O inability to walk due to pain,swelling and restriction of movement. • She gives H/O wt loss,loss of appetite but she has no H/O pain,swelling,deformity in other parts of body.
- 28. • On localexamination- an ill defined diffuse swelling occupying over the supracondylar region of the left thigh with shiny skin and presents of engorged vein and wasting of the thigh and leg. • She has a deformity of knee and cannot walk without support.
- 29. • The surfaceof swelling smooth, margin- ill- defined, local temperature-raised , tenderness present, over lying skin is free, consistency-hard, not movable and fixed with underlying structure. • Shortening of the left limb was found 3 cm than the right. She was unable to walk without support.
- 30. • There wasgross muscle wasting in left Lower limb, measuring thigh- 4cm, leg- 2 cm. • Neuromuscular status of left lower limb normal and regional lympnodes are not enlarged.Movement of the left knee joint absent hip and spine are normal. • On respiratory system examination-there was a dullness in Rt upper and lower zone of lung and breath sound also diminished in same area.Other system examination reveals no abnormality.
- 37. • Extensive bonedestruction is seen in the left lower femoral shaft, condyles and tibialcondyles with soft tissue extension. • peripheral calcification also seen. • Bone destruction also seen in L5 vertebra.
- 38. Multiple metastatic nodulesin both lungs along with Rt. Sided Hydro-pneumothorax-
- 40. S. creatinine0.6 mg/ dl Blood urea 30 mg / dl S. calcium 7.5 mg / dl S. alkaline phosphates 110 IU/ L SGPT:26 IU/L , SGOT :33 IU/L S. bilirubin:1.0 mg/dl • FNAC- Sarcomatous leison,suggestive of osteosarcoma. • Biopsy (incisional): Feature of osteosarcoma with osteod formation and many giant cells.