Reference no: EM133675019

Question

A 42-year-old female patient was admitted to the hospital with a swelling on the right tibia. Past history revealed that the patient was operated upon 24 years ago for a pathological fracture of the right tibia and the diagnosis at that time had been adamantinoma. The preoperative radiograph of the right leg showed osteolysis of the bone and the chest radiograph revealed lung metastases. Regional computed tomography (CT) of the right leg showed that the tumor was invading the surrounding soft tissues. The cortex appeared moderately expanded and attenuated. Bone scanning showed intensive positivity in the middle of the right tibia. The CT scan of the thorax demonstrated two lung metastases. One of these was in close contact with the right anterior pulmonary artery and the other was located in the left posterior lobe. Fine needle aspiration (FNA) biopsy confirmed the diagnosis of adamantinoma of right tibia suggesting local recurrence.

The patient underwent surgery wherein the tumor was widely resected and the tibia reconstructed with specific recombined osteosynthesis (salvage surgery). The pathological examination of the excised tumor confirmed the diagnosis of adamantinoma set by FNA biopsy. The histological examination revealed a multiforming adamantinoma with basaloid, spindle cellular, and tubular characteristics. Examination of the adamantinoma that had been excised earlier revealed the same characteristics. The postoperative period was without complications and the patient walked in 15 days.