I am not sure if my previous email reached you, so I will repost this,
apologies if you received this twice
I have posted a question regarding this patient *a year ago*, regarding
fibular stump which seems modified in MRI signal and we all agreed that it
was osteoradionecrosis – see the Pdf file attached – from the old email.
Patient doctors from Vienna agreed also, and recommended follow up
She came now for a follow up and fibula is fine, as expected.
But* I see a lot of changes in tibial site* – the resection of the tumor
involved some scraping of the tibial cortex and on previous MRI’s there
were some tibial modification due to radiotherapy, most of them punctated –
probably due to marrow reconversion.
But now I see a fracture line inside all that modifications (there area of
BME is larger than last time) and some periosteal reaction (inflammatory I
would say). I see no restricted diffusion on ADC so…
I ask your opinion:
*– is it the also osteoradionecrosis with fracture due to bone
fragility?After almost 2 years from radiotherapy?– should I worry and
recommend a biopsy?*
Thank you!
sorin
On Fri, Jan 29, 2021 at 1:14 PM sorin ghiea <sorin.ghiea@gmail.com> wrote:
> Dear ocaders,
>
> I ask again for your advice.
> 42 years old female, osteosarcoma of the proximal fibula.
> Surgery abroad, dedicated sarcoma center, oncological margins preserved,
> curetage of the adjacent tibia, everything went fine (chimio+radio)
> July 2020 no recurrence, some tibial areas probably due to radiotherapy
> January 2021, after 8 month, tibia is now fine, all areas disappeared, but
> there some area of BME (?) ot the tip of the fibular stump.
> Some enhancement, not much restriction on DWI, Xray looks normal to me.
> Periosteal reaction at the proximal stump?
>
> The question is:
> – could NOT be tumor recurrence? There is no mass just diffuse signal
> change and enhancement, and this is clearly not seen on the previous
> examination…and DWI is not very worrying to me (am I wrong?)
> – is it possible to have some late radiation reaction so late (>1 year
> since the radiotherapy) ?
> – would you do PET-CT? follow up?
>
> Thank you,
> Sorin
>
>
>
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fibular-old-exam-2021.pdf
