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A 29-year old male patient presents to your clinic after 3 months of medial left knee pain that is worse when standing for a long period of time and after his weekly workgroup kickball games. Initially, he thought it was arthritis in his knee, but there is associated swelling on the inside of his knee that made him concerned. He denies any neurologic symptoms or unexplained weight loss. Figures A are X-rays and select MRI cuts performed in your clinic. Figure B is a biopsy specimen. What is the tissue of origin for this lesion?
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A 17-year-old female presents to your office with a mass on her calf that has been present for 3 years. It does not cause pain and has not been growing in size overall but does enlarge towards the end of the day. Physical examination demonstrates a 2cm non-tender mass near the Achilles tendon without skin discoloration. The patient has a normal neurovascular examination of the extremity, and no other masses are found elsewhere. Advanced imaging is shown in Figures A-C. A biopsy was previously performed by an outside surgeon. What does the biopsy most likely demonstrate and what is the best treatment at this time?
Spindle cells in a wavy arrangement with positive S100 staining, wide resection and radiation
Vascular dilations with erythrocytes and some striated muscle cells, observation
Small round monotonous blue cells in pseudo-rosettes, chemotherapy followed by marginal excision
Angiofibroblastic hyperplasia with disorganized collagen, observation
Hemosiderin stained multinucleated giant cells, marginal excision
A 17-year-old male presents to your office with hand swelling and intermittent pain. His pain occurs when his hand is held in a dependent position or when he is swimming. While he was born with a birthmark on his hand, he has noticed it is progressively getting bigger. Clinical photograph, radiographs, and histology are shown. What is the most likely diagnosis?
Giant cell tumor of tendon sheath
A 30-year-old female presents with a painful posterior knee mass. The mass gets larger and more painful with activity. Examination reveals a boggy soft tissue mass about her knee. Radiograph and MRI are shown in Figures A and B. What is the most likely diagnosis?
Pigmented villonodular synovitis (PVNS)