Dear ocaders,
this patient had surgery for a quite big tumor – chondromyxoid fibroma
the defect was filled with cement
– 3 month after surgery, seemed fine – there is some gap between cement on
bone (last slice)
– after 15 month, it seems to me there is some loosening of the cement
especially upper pole, with some sclerotic margins at some distance from
the cement
Do you have experience with this kind of imaging? Is it normal? Should the
cement integrate perfectly? is it cause of concern? Should be reported?
Should perform an MRI?
Patient is very well clinically, pain free (she was not pain free at 3
month…)
thank you !
sorin
cement.pdf 
Thank you all for your quick responses
To summarize:
Opinions were divided – 70/30 in favor of normal finding vs tumor recurrenceI will follow up this at 7 month with CT again, and see how it goes. After reading that nice article from Dr. Pushpa, I indeed believe that is normal due to exothermic reaction and then, after 1 year, osteosclerosis at some distance from the cement. It seems that as long as this distance is no more than 5mm, it is fine. I will cite some email thank you all for taking the time!
sorin
———————–This lucency is related to the exothermic reaction of cement to bone and formation of granulation tissue. Lucency of no more than 5mm with regular sclerotic rim is related to the cement reaction to the bone. Otherwise you should follow up closely to rule out recurrence. A reference article attached below, however its based on treatment in GCT. Hope it answers your query.
———————————————————————–
Cement usually fills portion of Tumor – not 100% in tumors like gct or cmf – esp on CT.
It’s like pneumothorax after lung biopsy, not visible on Cxr but almost always seen on chest CT, but asymptomatic.
The lucency is stable and getting a sclerotic margin – it is to be left alone – just to be be watched annually at this stage!
Increased pain, lobulation, growth of Lucency without sclerosis, path fx or soft tissue mass are concerning features for future ref- not in this case!
———————————————————-
Findings suggest tumor recurrence or resisual at the cement bone interface .
———————————————————–
Nice case from a relatively rare tumor. I would advocate for MRI with and without contrast and would think recurrence is most likely. The exothermic cement can produce a thin lucency around the margins in the immediate postoperative time point but I don’t think it should not grow over time. Of course some micromotion of the cement bolus could produce a similar appearance, but tumor recurrence at the curettage margin would need to be excluded and followed closely.
-=———————————————————–I believe this is normal.The only real difference I see is a thin rind of sclerosis at the edge of what had been a zone of low attenuation at the cement-bone interface.I don’t see a recurrent lytic lesion.So long as she remains pain free, I would get follow up CT in 6 months….you have an excellent post-operative baseline.Don’t change modalities, that might only confuse you.
———————————————————-Consider tumor recurrence.
—
S O R I N G H I E A
Radiologie-Imagistica Medicalahttps://radiologhiea.ro/
https://www.spitalulmonza.ro/medic/dr-sorin-ghiea/https://centrokinetic.ro/despre-noi/echipa-centrokinetic/sorin-ghiea/
https://soringhiea.buzzsprout.com↗️
Thank you all for your quick responses
To summarize:
Opinions were divided – 70/30 in favor of normal finding vs tumor
recurrence
I will follow up this at 7 month with CT again, and see how it goes.
After reading that nice article from Dr. Pushpa, I indeed believe that is
normal due to exothermic reaction and then, after 1 year, osteosclerosis at
some distance from the cement.
It seems that as long as this distance is no more than 5mm, it is fine.
I will cite some email thank you all for taking the time!
sorin
PS: I also posted this email as a comment to ocadmsk.com archive, I
encourage all to use this nice functionality.
———————–
This lucency is related to the exothermic reaction of cement to bone and
formation of granulation tissue. Lucency of no more than 5mm with regular
sclerotic rim is related to the cement reaction to the bone. Otherwise you
should follow up closely to rule out recurrence.
A reference article attached below, however its based on treatment in GCT.
Hope it answers your query.
[image: image.png]
———————————————————————–
Cement usually fills portion of Tumor – not 100% in tumors like gct or cmf
– esp on CT.
It’s like pneumothorax after lung biopsy, not visible on Cxr but almost
always seen on chest CT, but asymptomatic.
The lucency is stable and getting a sclerotic margin – it is to be left
alone – just to be be watched annually at this stage!
Increased pain, lobulation, growth of Lucency without sclerosis, path fx or
soft tissue mass are concerning features for future ref- not in this case!
———————————————————-
Findings suggest tumor recurrence or resisual at the cement bone interface
.
———————————————————–
Nice case from a relatively rare tumor. I would advocate for MRI with and
without contrast and would think recurrence is most likely. The exothermic
cement can produce a thin lucency around the margins in the immediate
postoperative time point but I don’t think it should not grow over time.
Of course some micromotion of the cement bolus could produce a similar
appearance, but tumor recurrence at the curettage margin would need to be
excluded and followed closely.
-=———————————————————–
I believe this is normal.
The only real difference I see is a thin rind of sclerosis at the edge of
what had been a zone of low attenuation at the cement-bone interface.
I don’t see a recurrent lytic lesion.
So long as she remains pain free, I would get follow up CT in 6
months….you have an excellent post-operative baseline.
Don’t change modalities, that might only confuse you.
———————————————————-
Consider tumor recurrence.
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