 Hello everyone, welcome to the case review session of 421. Let's review this case. This is a case of a 20-year-old man who presented with a painless, hard mask in the POPLITEL course of. He stated that the mask had been present for several years and did not change in size. This is the lateral radiograph of the knee of the patient and we will evaluate this lesion on the following. The first is age of the patient. As we know age of the patient is 20 years so he is a young male. Second whether the lesion is single or multiple so as we can see the lesion is single. The skeletal location so as we can see the lesion is involving appendicular skeleton and is involving long bone that is distal femur. What is the site of long bone involvement? As we can see the lesion is involving metaphysis of distal femur and the lesion is pointing away from the joint. Pattern of growth and bone destruction so the lesion is basically a bony outgrowth with no obvious destruction. There is no obvious periosteal reaction and matrix mineralization and the lesion can impinge on the adjacent soft tissue. So this is the case of a societal bony outgrowth as the distal femur metaphysis the femoral cortex and medulla are continuous with dose of the lesion. So this is the case of societal osteocondroma or exostosis. Osteocondroma is a benign cartilaginous tumors but there are certain features which suggest malignant transformation into chondrosarcoma and this malignant transformation is seen in less than 1% cases of solitude osteocondroma and 20% cases in diaphyzel ecclesia. So the rate of malignant transformation is higher in diaphyzel ecclesia. So there are certain clinical and radiographic features which suggest malignant transformation. The clinical features are advanced age lesions in the pelvis and shoulder and increasing pain and mass at the site of no mostopondroma. Whereas the radiographic features are thick and irregular calcified cap bone destruction soft tissue mass and altered appearance on sequential studies. This is the radiograph showing multiple sysile and pedunculated osteocondroma's involving bone surrounding bilateral knee joint. So this is the case of diaphyzel ecclesia and rate of malignant transformation in diaphyzel ecclesia is around 20%. This is the case of solitary pedunculated osteocondroma and the direction of osteocondroma is away from the joint. This is the case of osteocondroma involving neural arch of the cervical spine and this is the CT of the same patient. This is the case of a 1 year old female who presented with tender swelling all over the body with rashes and enlarged lymph nodes. These are multiple radiographs of the patient covering skull and long bones of upper and lower limbs. So again we are going to evaluate this lesion on the basis of multiple criteria which include first the age of the patient. So this is the case of 1 year old female so this is a very young child. Second the lesions are single or multiple such again see there are multiple lesions Skeletal location such as you can see the lesions are involving axial as well as appendicular skeleton. Sites of long bone involvement as you can see the lesions are involving diaphysis and metaphysis of long bones. Pattern of growth and bone destruction so these lesions are having geographic and moth-eaten pattern of bone destruction. There is no obvious periosteal reaction and there is no obvious matrix mineralization and these lesions are having adjacent shock tissue involvement near the austenitic lesion. So this is the case of a 1 year old child with systemic symptoms and multiple well-defined punched out lytic lesions in skull and long bones. So this is the case of Lengar and cell osteocytosis. So Lengar and cell osteocytosis can be divided into three categories. First is the unifocal or localized form. Second is multifocal unisystem, chronic regal inform and third is the multifocal multisystem fulminant form. The first category is unifocal or localized form which effects which actually composes of 70% of LCH cases and it is limited to single bone or few bones and it may involve the lung. It affects 5 to 15 years of age. Second is the multifocal unisystem form which comprises 20% of cases. It affects multiple bones as well as reticulitis to your system like liver, spleen, lip nodes and skin. It is often accompanied by diabeties insipidus because of involvement of the pituitary gland and the age group involved is 1 to 5 years of age. The third and the most severe or fulminant form is multifocal multisystem form which comprises 10% of LCH cases and it is often fatal. It is typically diagnosed in the first two years of life and it is characterized by disseminated involvement of the reticulomethalyl system leading to anemia and thrombocytopenia. So LCH has a predilection for the flat bones. Skull is the most common flat bone involved followed by mandible, ribs, pelvis and spine and skull lesions have characteristic beveled edge because of unequal involvement of the outer inner table and it gives an appearance of geographic skull. So this is the radiograph showing lesion in the skull having beveled edge and geographic skull appearance. Symmetric uniform collapse of the vertebral body is a frequent finding and it is known as vertebra plenum. The femur, humerus and tBR are the most commonly involved on bones. Destruction of the mandible isolates and displaces the tooth which gives rise to floating teeth sign. This is the radiograph of the mandible showing floating teeth sign. So this was all about Langer and Sinistrocytosis which predominantly affects pediatric age group. This is the case of a seven year old male who presented with swelling in the right of the male arm for five months. This is the parental radiograph of the right shoulder of the patient and again we are going to evaluate this lesion on the basis of following criteria. First is age of the patient. So age of the patient is seven years with a skeletally immature patient. The lesion is single, skeletal location is a bandicular skeleton involving long bone. Site of long bone involvement is metadiphyseal and it is central with mild expansion. Pedontop both and bone destruction. So the lesion is having geographic pedontop bone destruction with narrow donor transition. There is no obvious periosteal reaction and there is no obvious matrix mineralization and there is no obvious soft tissue involvement. So this is the case of a well defined mildly expansional central lytic lesion located in the proximal humerus metadiphyzer in location. So this is the case of simple bone cyst also known as mini-cameral bone cyst. Simple bone cyst is not a troneoplasm. The most common sites of involvement include proximal humerus, proximal femur and calcinius. It is predominantly metadiphyseal and diphyzerin location. The lesions have geographic pattern of bone destruction. These are central elongated lesion with mild expansion and osteoskeleton and with no obvious periosteal reaction. Ethological fracture can be seen and it can be the first clinical sign. Fallen fragment sign is seen in 10% of cases. This is the radiograph of left hip joint showing simple bone cyst with complicated ethylogical fracture. This is another radiograph of the proximal humerus showing simple bone cyst with fallen fragment sign. This is another case of simple bone cyst involving proximal humerus with the chronological fracture in a skeletally immature patient. Efficient diagnosis will also include fibroid dysplasia. So this was all about simple bone cyst or mini-cameral bone cyst. This is the case of a 28-year-old male who presented with bilateral hip pain and this is the ethylograph of the pelvis by bilateral hip joint and also including bilateral femur. So again we are going to evaluate these lesions on the basis of following criteria. First is age of the patient. As you can see the age of the patient is 28 years. The lesions are multiple skeletal location and the pendicle skeleton is involving long bone. The site of long bone involvement is predominantly diaphysiol but it is also involving metaphysis. Pedinob bone and bone destruction. So these lesions are causing bone expansion with endosteal scaloping and cortical thinning. There is no obvious periosteal reaction and if at all it is present it is of non-aggressive type. There is no obvious matrix mineralization and sub-issue involvement. So this is a case of expansion of bilateral femur with endosteal scaloping, cortical thinning, ground coughing and bone. So this is a case of polyostatic fibres dysplasia. Fibre dysplasia are benign lesions. These lesions are basically asymptomatic and bone deformities and pathological fracture are the most common causes of symptoms. Bone deformities are called as shepherd group deformities. Cephalase parts are seen in 30% of patients with polyostatic fibres dysplasia. Nitunal write syndrome represents polyostatic fibres dysplasia with skin pigmentation and precocious puberty. This is the case of a 12-year-old male who is represented with sweating in bilateral hands. This is a peer radiograph of bilateral hands of the patient. So we are going to evaluate lesions on the basis of foreign criteria. First is age of the patient. So age is 12 years and he is a skeletally immature patient. Lesions are multiple. Charter location is a perpendicular skeleton involving small bones of hands. The site of long bone involvement is metadiphyzium. The pattern of growth and bone destruction. So the lesions are causing eye contact like lesions with geographic pattern of bone destruction and endosteal scaloping. Hyperperiostal reaction is non-aggressive side. Phenomenal matrix mineralization with cartilaginous matrix with ring and r-pattern of capacitation and there is no obvious soft tissue involvement. So this is the case of expansion like lesions with geographic phenomenal bone destruction and endosteal scaloping involving multiple small bones of both hands. So this is the case of old-year disease or concomitosis. So old-year disease, the non-hereditary sporadic skeletal disorder characterized by presence of multiple angondromas and there is an increased risk of condosarcoma which can occur in later stages of life. So old-year disease is associated with presence of soft tissue manchurma characterized by presence of flagellate on the reticula. This situation is known as macrosis syndrome. So this was all about old-year disease or angondromatosis. I hope you have enjoyed the video. Thank you.