Metastatic or metachronous adamantinoma: An Enigma
A 21 year old male, presented with pain and swelling of the right thigh of six months duration. A definitive treatment of above knee amputation of left leg for adamantinoma of tibia had been performed five years back []. Whole body scan was done before amputation and no other lesions were detected anywhere else in the body. X rays showed presently a multilocular, osteolytic, expansile lesion in diaphysis of right femur with cortical thinning. There was no evidence of cortical breach or a pathological fracture []. A radiological diagnosis of aneurysmal bone cyst was rendered. There was no regional lymphadenopathy. Fine needle aspiration of the swelling was inconclusive. Hence a diagnostic biopsy was performed by curetting the osteolytic lesion. Microscopically typical epithelial islands of basaloid cells with peripheral palisading, separated by fibrous septa were seen []. The relative amounts varied from predominantly epithelial islands with little intervening stroma to predominantly fibrous with small islands of cells. Unusual, rarely described feature was presence of multinucleate osteoclastic giant cells abutting the islands and in the septae []. On review, they were not seen in the initial tibial lesion [].