Detailed Treatment Process
5 min read
Female, 27 years old The following is the discharge summary from four years ago Department: Orthopedic Surgery Admission diagnosis: Right acetabular tumor (nature to be determined) Admission date: May 20 Procedure: Right hip tumor curettage and pelvic bone grafting Procedure date: June 8 Discharge diagnosis: (Right pelvis) giant cell tumor of bone with secondary aneurysmal bone cyst Discharge date: June 23 Admission status: (Brief history, positive physical findings, relevant laboratory and imaging results) The patient, a 24-year-old woman, was admitted with “right hip pain for two months, worsening with limp for two weeks.” She reported that two months earlier, without obvious cause, she developed aching pain in the right hip. Prolonged walking caused weakness in the right lower limb. She did not seek treatment at the time. In the past two weeks the pain gradually intensified, with night pain and pain at rest, along with a limp but no numbness in the right lower limb. She came to our hospital for treatment, and the outpatient department admitted her with a suspected diagnosis of “right acetabular tumor.” Since onset, her mental status has been normal, sleep and appetite good, bowel and bladder function normal, and body weight unchanged. Physical examination: no obvious abnormalities in heart, lungs, or abdomen. Specialist examination: Right hip not swollen locally, no redness or increased heat, minimal tenderness or percussion pain. Localized light brown pigmentation on the skin at the midpoint of the right inguinal region, with slightly elevated skin temperature. A mass of slightly firm texture and tenderness could be palpated at the midpoint of the right inguinal region. Thomas sign negative, right lower limb 4-sign positive. Right hip flexion 0–110 degrees, external rotation 40 degrees, internal rotation 40 degrees. Mild edema of the right lower limb, no numbness, normal skin sensation. No obvious abnormalities in the other limbs. Ancillary examination: X-ray showed osteolytic changes in the right acetabulum. Hospital course: After admission, preoperative examinations were completed. On May 24, percutaneous biopsy of the bone tumor was performed in the interventional radiology department. The procedure was uneventful and the patient returned to the ward in stable condition. Pathology report from our hospital: consistent with giant cell tumor of bone with secondary aneurysmal bone cyst; highly malignant telangiectatic osteosarcoma could not be excluded. Consultation with the pathology department of a specialized tumor hospital: aneurysmal bone cyst; secondary aneurysmal bone cyst could not be completely ruled out. On June 8, under general anesthesia, “right hip tumor curettage and pelvic bone grafting” was performed. The operation went smoothly. Postoperative care included anti-infective measures, edema reduction, fluid supplementation, bone nutrition support, blood transfusion, and analgesia. The right lower limb was placed in tibial tubercle traction. The resected tumor was sent for pathology, which reported: (right pelvis) giant cell tumor of bone with secondary aneurysmal bone cyst, focally active growth. The patient is now in stable condition and is being discharged. Discharge status: Cured Wound healing: Grade I/primary healing The patient had no fever, normal sleep and appetite, and normal bowel and bladder function. Physical findings: Alert and oriented, good mental status, incision healing well without redness, swelling, or exudate. Normal sensation in the right lower limb, normal toe movement. Discharge instructions: 1. Avoid weight-bearing on the affected limb; 2. Return for specialist outpatient review in one month; bring all medical records; 3. Prevent upper respiratory tract infection and wound infection; avoid pressure sores; 4. Monitor condition closely and return if any discomfort occurs.
The following is this year’s magnetic resonance imaging report Report date: May 14, 09:59 Examination: Plain and contrast-enhanced pelvic MRI Imaging findings: A multilocular mass is seen in the pelvis, measuring approximately 12.9 cm × 9.3 cm × 13.6 cm, with ill-defined borders. The upper margin reaches below the iliac vascular bifurcation, displacing the right iliac vessels. The lower margin reaches the superior border of the pubic symphysis. The lesion shows low signal on T1-weighted images and heterogeneous high signal on T2-weighted images, with fluid levels in some cysts. The lower layer shows low signal on T2-weighted images. Septations within the lesion vary in thickness. On DWI, parts of the lesion wall and internal septations show high signal. After contrast administration, the lesion wall and internal septations show marked enhancement. The right acetabulum has an irregular shape with indistinct borders relative to the mass. The right pubis and ilium are expanded with mixed signal intensity: low on T1 with focal slight high signal, and mixed high and low on T2. Heterogeneous marked enhancement is seen after contrast. The uterus, bladder, and portions of the bowel are compressed and displaced to the left. Multiple follicular structures are visible in both ovaries. Multiple enlarged lymph nodes are present in the right inguinal region, some confluent, showing marked enhancement after contrast. Impression: Occupying lesion in the pelvis and right hip bone, considered giant cell tumor of bone with possible malignant transformation; multiple enlarged lymph nodes in the right inguinal region.
The family mentioned that at this point an orthopedic surgeon (hospital unspecified) recommended a 3D-printed artificial pelvic replacement procedure costing $300,000. The family then sought second opinions through personal connections. Other physicians pointed out that the enlarged lymph nodes suggested distant spread of the disease and posed a life-threatening risk. The patient died three months later. It is not known whether she ultimately underwent the artificial pelvic replacement suggested by the orthopedic surgeon.