title: Osseous haemophilic pseudotumour and concurrent primary hyperparathyroidism: a diagnostic conundrum.
abstract: Pseudotumours are rare, occurring in 1-2% of severe haemophiliacs. Osseous locations are far less frequent than soft tissue location. We report a case of a 43-year-old man with haemophilia A, who presented with a gradually enlarging left thigh mass for 8 months. There were no constitutional symptoms. Plain radiograph showed an expansile lytic lesion with 'soap-bubble' appearance arising from the left femur diaphysis. On MRI, it appeared as a non-enhancing, multilobulated lesion expanding the medullary and subperiosteal spaces. The mass exhibited concentric ring sign with heterogeneous intermediate signal intensity in the core lesion, reflective of chronic haematoma with blood degradation products of different stages. A diagnosis of haemophilic pseudotumour was made. Hypercalcaemia, however, raised a diagnostic dilemma as bone malignancy needed to be considered. An open excisional biopsy and subsequent amputation confirmed the diagnosis of osseous haemophilic pseudotumour. Nuclear medicine study later revealed a concurrent parathyroid adenoma.
authors.affiliation: Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Soo Fin
authors.initials: SF
authors.lastname: Low
authors.forename: Radhika
authors.initials: R
authors.lastname: Sridharan
authors.forename: Chai Soon
authors.initials: CS
authors.lastname: Ngiu
authors.forename: Nor Hazla Mohamed
authors.initials: NH
authors.lastname: Haflah
mesh_terms: D000328:Adult; D005266:Femoral Neoplasms / Q000150:complications*; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications*; D008297:Male
references.citation: Curr Probl Diagn Radiol. 2011 Sep-Oct;40(5):191-7
references.pmid: 21787985
references.citation: JBR-BTR. 2004 Nov-Dec;87(6):289-93
references.pmid: 15679027
references.citation: J Bone Joint Surg Am. 1975 Dec;57(8):1133-6
references.pmid: 1202003
references.citation: Skeletal Radiol. 1988;17(2):152-6
references.pmid: 3363387
references.citation: Ann Surg. 2004 Apr;239(4):528-35
references.pmid: 15024314
references.citation: Am J Hematol. 1994 Feb;45(2):103-8
references.pmid: 8141115
references.citation: AJR Am J Roentgenol. 1987 Jan;148(1):115-9
references.pmid: 2947433
references.citation: Skeletal Radiol. 1996 Jan;25(1):85-7
references.pmid: 8717129
references.citation: Radiographics. 2003 Jul-Aug;23(4):852-6
references.pmid: 12853660
references.citation: AJR Am J Roentgenol. 2004 Jul;183(1):55-61
references.pmid: 15208110