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thigh region (neurological examination of the lower limb (could be as a…

- - - - the knee joint is synovial,condyloid, complex joint
  - - - flex at hip and extend at knee joint
    - - extend the thigh at the hip joint and flex the leg at the knee joint
    - - adduct the thigh at the hip joint
  - - - its origin is the continuation of external iliac artery behind the inguinal ligament
      - course: runs in the femoral triangle from the base to the apex and then runs in the adductor canal
      - termination: it continue as the popliteal artery after passing through adductor hiatus
      - branches
        
        3 superficial
        
        3 deep
- - - - MRI
        
        to get more detailed look at a bone mass seen on an X-ray
      - CT scan
        
        to look for the spread of cancer to other body parts
      - X-ray
      - positron emission tomography (PET) scan
        
        helps in checking how well the cancer is responding to the treatment
- - - - erratic and may be slow to rapid, mitotic figures may be numerous and abnormal
        
        the rate of growth of malignant tumors usually correlates inversely with their level of differentiation
        
        locally invasive, infiltrating surrounding normal tissue
  - - - usually progressive and slow, may come to a standstill or regress, mitotic figures are rare and normal
        
        well demarcated masses that do not invade or infiltrate surrounding normal tissues
        
        local invasion
        
        rate of growth
      - differentiation / anaplasia
- - - - miscellaneous
        
        osteo-
        
        osteoma
        
        primary osteosarcoma
        
        osteoid osteoma
        
        osteoblastoma
        
        secondary osteosarcoma
        
        giant cell tumor of bone
        
        Ewings sarcoma
      - osteochondroma
      - chondrosarcoma
      - enchondroma
- - - - there is 2 types
        
        needle biopsy
        
        local anesthesia--small incision--needle inserted to bone
        
        open biopsy
        
        general anesthesia--large incision--surgically bone piece is removed
- - - - primary osteosarcoma
        
        caused by genetic factors
        
        mutation in Rb / P53 genes
        
        60% occur around the knee
        
        proximal of the humerus
        
        lower end of the femur
        
        upper end of the tibia
        
        proximal femur
        
        grossly it is large bulky mass at the metaphysis of the long bones
        
        may lead to pathological fractures
        
        microscopically
        
        there is osteoblastic areas
        
        spindle shaped cells
        
        in between there is osteoid formation pink color
        
        other violet areas due to the calcification
        
        pleomorphism
        
        many mitotic figures
        
        radiological features
        
        codmens triangle
        
        sun burst appearance
      - secondary osteosarcoma
        
        happen due to ionizing radiation or pre-existing bone lesions like pagets disease,chronic osteomylitis
    - - osteoblastoma
        
        the pain cannot be relived by aspirin
        
        occur mainly in the vertebral column (medulla) at the spinous and transverse processes
        
        the nidus is not surrounded by sclerotic zone
        
        larger than osteoid osteoma which is more than 2 cm
      - osteoid osteoma
        
        occur in the metaphysis of long bone (cortex)
        
        tibia
        
        femur
        
        radiologic features
        
        small radiolucent focus (nidus)
        
        surrounded by sclerotic zone
        
        evokes pain but it is relived by aspirin
        
        grossly
        
        small round mass less than 2 cm
        
        well circumscribed
        
        hemorrhagic and gritty
        
        microscopic features
        
        interlacing trabeculae of woven bone rimmed by osteoblasts
        
        in between there is loose vascular connective tissue stroma
      - osteoma
        
        occur in the bones that undergo intramembranous ossification
        
        maxilla and mandible
        
        air sinuses (frontal ethmoid)
        
        skull
        
        radiologic features
        
        round and radio dense
        
        grossly
        
        exophytic sessile mass
        
        ivory like
        
        microscopic features
        
        mature dense compact cortical bone (woven and lamellar)