Pathological lesser trochanter fracture

Case contributed by Dr Henry Knipe

Presentation

Unable to weight bear with pelvis/hip pain.

Patient Data

Age: 65 years
Gender: Female
Modality: X-ray

Alignment within normal limits. Multiple lytic lesions in the proximal left femur and a probable lesser trochanter fracture. No other fracture is seen.

99mTc MDP

Modality: Nuclear medicine

On the delayed images, moderately intense tracer uptake is noted in the right subtrochanteric region. No other suspicious foci are seen elsewhere.

Modality: CT

Expansile lytic lesion centred on the right lesser trochanter with cortical destruction and thinning. Central soft tissue density. Lucency through the base of the lesser trochanter in keeping with a pathological fracture. There are multiple other cortically based lytic lesions within the right proximal femoral metadiaphysis.

CT guided bone biopsy was performed. 

Histology

MICROSCOPIC DESCRIPTION: The biopsy shows reactive woven bone infiltrated by carcinoma comprising sheets, nests and trabeculae and of moderately pleomorphic epithelial cells within fibrotic stroma.

DIAGNOSIS: Right femur biopsy: Metastatic carcinoma.

Case Discussion

Isolated lesser trochanter fractures in adults should be considered pathological until proven otherwise. In elderly patients, the most common lesions are metastasis, myeloma or lymphoma. This patient had a history of breast cancer treated a few years ago. 

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Case Information

rID: 50148
Case created: 21st Dec 2016
Last edited: 24th Dec 2016
Inclusion in quiz mode: Included

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