Presentation
Pain left lower leg for four months. No history of trauma, fever or weight loss.
Patient Data
Mildly expansile eccentric osteolytic lesion with non-sclerotic margin in the distal medial epimetaphysis of the left tibia associated with some cortical thinning. No obvious fracture is seen. Mild soft tissue swelling along the medial aspect of ankle joint.
Well-defined mildly expansile eccentric lesion involving the distal metaphysis of left tibia with epiphyseal extension, measuring about 47 x 35 x 28 mm. The lesion is of low signal intensity on T1, high signal intensity on T2-weighted images in comparison to the marrow signal, has peripheral sclerotic margin and shows enhancement on the post-contrast study. Perilesional bone marrow edema, disruption of the distal cortical margin associated with periosteal elevation and small subperiosteal fluid collection are also noted. No hemorrhage or fluid-fluid level are seen. Articular surface of the tibiotalar joint is intact.
After the imaging work up (x-ray & MRI), the patient was referred to a tertiary care center where he underwent ultrasound guided biopsy of the lesion by the musculoskeletal (MSK) radiologist.
Status post resection/curettage of the distal tibial lesion, The defect has been filled with bone cement. A metallic plate with multiple screws is also seen along the distal tibial shaft.
Case Discussion
Based on the imaging features, a provisional diagnosis of giant cell tumor was given which was later on confirmed histopathologically.