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Diagnostics Histology, Training and education, Microbiology and immunology

Case of the Month

A 20-year-old female presented with fever of unknown origin, normocytic anemia, neutrophilia, diffuse lymphadenopathy, and splenomegaly for several months. Bone marrow biopsy was performed.

What is the most likely diagnosis?

a. Gaucher disease
b. Myeloproliferative neoplasm with numerous pseudo-Gaucher cells
c. Mycobacterial infection
d. Crystal-storing histiocytosis
e. Niemann-Pick disease

Click here to register your guess.

We will reveal the answer next month.

Do you have an interesting case that you would like us to feature? Email it to [email protected].

The Case of the Month series is curated by Anamarija M. Perry, University of Michigan.

B. Osteochondroma

Osteochondromas are benign tumors composed of bone and cartilage that typically involve the metaphysis of the femur, humerus, and tibia. They are most commonly diagnosed in the first two decades of life (1). Presentation of osteochondromas within facial bones is extremely rare (2,3,4). These tumors are characterized by a well-defined hyaline cartilage cap containing small, mature chondrocytes without atypia. The chondrocytes may line up to mimic a normal growth plate. The cartilage transitions into trabecular bone via enchondral ossification, leading to expansion over time. It is important to recognize that this lesion is not permeating bone, which is seen in low-grade chondrosarcoma (4). Instead, it is forming bone via endochondral ossification, which rules out enchondroma, a neoplasm solely made of cartilage. Chondroblastic osteosarcomas must have a malignant-appearing cartilage for diagnosis (1).

Submitted by Chelsea Styles, The University of Michigan, Ann Arbor, Michigan, USA.

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  1. SA Qasem, BR DeYoung, “Cartilage-forming tumors”, Semin Diagn Pathol, 31, 10 (2014). PMID: 24680178.
  2. H Tutar et al., “Osteochondroma of the nasal dorsum presenting as a nasal hump”, Ear Nose Throat J, 93, 75 (2014). PMID: 24526480.
  3. Hh Unlu et al., “Osteochondroma of the posterior nasal septum managed by endoscopic transnasal transseptal approach”, J Laryngol Otol, 116, 955 (2002). PMID: 12487678.
  4. AW Barrett et al., “Oral presentation of secondary chondrosarcoma arising in osteochondroma of nasal septum”, Int J Oral Maxillofac Surg, 25, 119 (1996).  PMID: 8727583.

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