Presentation
Pain of the left hip
Patient Data
There is a relatively well-defined eccentric osteolytic lesion of the left femoral neck, extending to the femoral epiphysis with a paucity of the trabecular lines as compared to the normal opposite side, and thinning of the overlying cortex. No peripheral sclerotic rim is seen (type 1b according to Lodwick classification).
The previously described lesion appears lobulated of intermediate signal intensity on T1WI with a peripheral rim of low signal, inhomogeneous high signal intensity on T2WI with areas of low signal intensity (due to hemosiderin or fibrosis) with intense and heterogeneous enhancement following IV contrast. A cortical rupture is noted at the anteroinferior aspect of the femoral neck with mild periosseous extension as well as adjacent bone marrow. mild joint effusion is noted.
Case Discussion
This case illustrates the characteristic radiological features of a giant cell tumor (histologically proven)
AP radiograph:
- eccentric osteolytic lesion close to the articular surface
- well-defined with non-sclerotic margins (Lodwick type Ib)
- no matrix calcification/mineralization
- no periosteal reaction
- extension to the epiphysis
- thinning of the overlying cortex
MRI:
- peripheral low signal intensity rim on T1WI
- heterogeneous high signal intensity on T2WI with central areas of low signal (hemosiderin or fibrosis)
- enhancement of the tumoral matrix
- bone marrow edema
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