B006400

Right humerus

 

The majority of the distal half of the bone is covered by new compact and woven bone.  Much of the central anterior half of this bone fragment and the anterior joint surface is unaffected.

 

Anterior surface- There is a large oval destructive lesion with sharp margins on the lateral border of the distal quarter of the shaft that penetrates an area of porous new woven bone. This woven bone overlies compact bone and the destructive lesions extend deep into the cortical surface leaving some trabeculae exposed.  The remaining distal end is a mix of bone destruction and irregular porous new compact bone deposition with areas of overlaying new woven bone. There are nodules of new compact bone at the common extensor tendon attachment. There is a septal aperture present allowing for an uninterrupted continuation of the new compact bone from the anterior to the posterior surface.

 

Posterior surface- There is a large amount of new compact bone mixed with porous woven bone covering the entire surface, causing the shaft to be considerably expanded posteriorly. There are multiple gummatous lesions (destructive lesions) in varying stages of activity and healing covering the inferior third of the bone.  Many of these lesions penetrate into the new bone, with some continuing into the cortical bone surface.  The majority of these lesions retain a sharp and irregular margin.  The olecranon fossa is bordered by striated new compact bone.  Approximately half of the lateral epicondyle has been destroyed posteriorly. There is a large spherical destructive lesion lateral to the trochlea that penetrates into the trabeculae, which has sharp margins and a smooth floor.  There is irregular joint surface destruction on the lateral half of the surface of the trochlea.

 

Radiographs reveal multiple ovoid translucencies with indeterminate margins that are the result of cortical destruction, rather than being internal voids.

 

Disease Classification:

 

Infective-specific-bacterial-treponemal

B006500

Left tibia

There is a mixture of compact bone and woven bone covering the majority of the distal third of the shaft, thickening the distal end, especially the anterior surface.

Anterior, medial and lateral surfaces- There is a large focal area of bone deposition in the superior half of the affected area of the shaft. This consists of a mixture of new compact bone and striated porous woven bone.  There are approximately eight small ovoid lytic lesions (gummatous lesions) that have sharp and well defined margins, which penetrate into the original cortical bone surface.  There is a larger lytic lesion (gummatous lesion) laterally that has less defined, irregular margins and floor.  Inferior to this large focal area the bone surface is covered in an irregular mixture of striated and smooth new compact bone, with a large portion on the medial surface having new woven bone overlaying.

Posterior surface- There is layer of striated new compact bone on the distal quarter of the shaft.

Radiographs reveal multiple ovoid translucencies with indeterminate margins that are the result of cortical destruction, rather than being internal voids.

Disease Classification:

Infective-specific-bacterial-treponemal

B006800

Cranium

There is a large active lytic lesion on the right side of the frontal superior to the super-orbital ridge, which penetrates from the outer table to the diploë (the inner table is still intact). It is a square circumvallate cavitation measuring 19.7mm at its largest diameter.  The superior margin is still sharp and the lesion is surrounded by pitting.  The remaining margins are rounded with a rim of new compact bone.  The floor of the lesion shows a mixture of bone destruction and nodular new compact bone formation. Inferior and lateral to this lesion is another that is in a more advanced state of healing. It measures 11.8mm at its maximum diameter and consist of rounded margins of new compact bone and large nodules of new compact bone filling the floor of the lesion.  Superior to glabella are two discrete depressions with radial scarring, with the inferior lesion having pitting. On the posterior surface of the right parietal near the sagittal and lambdoid sutures, there is a large depression with healed new compact bone and radial scarring.  Similarly, there is a healed radial lesion on the occipital above the nuchal crest.

Radiographs reveal multiple ovoid translucencies with indeterminate margins that are the result of cortical destruction, rather than being internal voids.

Co-existent Pathology:

There is bilateral pitting on the superior surface of the orbit.  The surfaces of the posterior parietals, the parietals along the sagittal suture, the right temporal, the right greater wing of the sphenoid, and the occipital are densely pitted.

Disease Classification:

Infective-specific-bacterial-treponemal

Miscellaneous-skeletal-cribra orbitalia

B007100

Sternum (manubrium and sternal body are fused)

There is a thick layer of irregular and porous new compact bone on all non-articular surfaces of the sternal body and manubrium.  The anterior surface of the manubrium has a thick layer of irregular and porous new compact bone and at least three zones of bone destruction.  The most superior and lateral lesion on the left is spherical and has sharp irregular margins and a smooth base.  The other two lesions are irregular in shape, penetrate the cortical surface and are filled with irregular new bone formation.  The right side of the manubrium is covered primarily in layers of thickly striated new compact bone. The anterior surface of the body is primarily covered in a layer of smooth new bone with areas of porosity and pitting (especially in the superior third).  The entire posterior surface of the manubrium and body is covered in multiple layers of irregular and highly porous new compact bone.   There is destruction to much of the left and right superior clavicular articular surfaces.  A circular destructive lesion on the right clavicular articular surface has sharp margins and a large underlying spherical cavity with smooth sides.

Radiographs reveal multiple ovoid translucencies with indeterminate margins that are the result of cortical destruction, rather than being internal voids.

 

Disease Classification:

Infective-specific-bacterial-treponemal

 

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