case_images: PMC6304848_01
case_images: AP and mortise radiographs of the ankle demonstrating a lytic, expansile, geographic bone lesion with no cortical disruption.
case_images: CRIONM2018-1574343.001.jpg
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case_images: fig1
case_images: Radiographs obtained demonstrated a lytic, expansile, geographic lesion with no cortical disruption or periosteal reaction (Figure 1).
case_images: STIR (short tau inversion recovery) weighted MRI of the ankle showing 5 x 5.2 x 3.6 cm multiloculated, expansile lesion with fluid-fluid levels.
case_images: CRIONM2018-1574343.002.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.002.jpg
case_images: fig2
case_images: MRI revealed a multiloculated, minimally enhancing, expansile lesion (Figures 2 and 3).
case_images: T1 weighted MRI of the ankle showing 5 x 5.2 x 3.6 cm multiloculated, slightly hyperintense compared to surrounding muscle expansile lesion.
case_images: CRIONM2018-1574343.003.jpg
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case_images: fig3
case_images: MRI revealed a multiloculated, minimally enhancing, expansile lesion (Figures 2 and 3).
case_images: Photomicrographs demonstrating the wall of an ABC partially lined by proliferation of bland fibroblasts (Black arrow) with underlying osteoclast-type giant cells (star) and blood (hematoxylin and eosin, x20).
case_images: CRIONM2018-1574343.004.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.004.jpg
case_images: fig4
case_images: ABC (Figure 4). A curettage, application of phenol, and allograft bone grafting were performed, and she was followed with serial radiographs.
case_images: T1 weighted MRI showing a homogeneously slightly hyperintense to muscle lobulated lesion with multiple fluid-fluid levels.
case_images: CRIONM2018-1574343.005.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.005.jpg
case_images: fig5
case_images: MRI showed a homogeneously lobulated, hyperintense lesion with multiple fluid-fluid levels confirming the recurrence (Figures 5 and 6).
case_images: STIR (short tau inversion recovery) weighted MRI showing a homogeneously lobulated, hyperintense lesion with multiple fluid-fluid levels.
case_images: CRIONM2018-1574343.006.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.006.jpg
case_images: fig6
case_images: MRI showed a homogeneously lobulated, hyperintense lesion with multiple fluid-fluid levels confirming the recurrence (Figures 5 and 6).
case_images: Pretreatment with denosumab: mortise radiograph showing a large lytic, expansile bone lesion with cortical disruption.
case_images: CRIONM2018-1574343.007.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.007.jpg
case_images: fig7
case_images: Serial radiographs were obtained throughout her treatment which showed increased mineralization and no further expansion of her lesion throughout the course of denosumab therapy (Figures 7 and 8).
case_images: Posttreatment with denosumab after 1 year shows increased mineralization and no further expansion or cortical disruption.
case_images: CRIONM2018-1574343.008.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.008.jpg
case_images: fig8
case_images: Serial radiographs were obtained throughout her treatment which showed increased mineralization and no further expansion of her lesion throughout the course of denosumab therapy (Figures 7 and 8).
case_images: Photomicrographs taken after denosumab treatment demonstrating fibrous connective tissue with bland-looking spindle cells (arrow), focal hemorrhage, and reactive bone formation (star) admixed with scattered inflammatory cells; multinucleated giant cells are absent.
case_images: CRIONM2018-1574343.009.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.009.jpg
case_images: fig9
case_images: Her histopathology at the time of surgery showed numerous fragmented bones admixed with fragments of fibrous connective tissue with bland fibroblasts with no significant component of multinucleated giant cells present (Figure 9).
case_images: Mortise radiographs taken at 10 months following denosumab treatment and surgery demonstrating no local recurrence.
case_images: CRIONM2018-1574343.010.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.010.jpg
case_images: fig10
case_images: She has been followed for three years with clinical and radiographic examination, has resumed all normal activity without pain, and has had no recurrence of her disease (Figures 10 and 11).
case_images: Mortise radiographs taken at 3 years following denosumab treatment and surgery demonstrating no local recurrence.
case_images: CRIONM2018-1574343.011.jpg
case_images: PMC6304848_01_CRIONM2018-1574343.011.jpg
case_images: fig11
case_images: She has been followed for three years with clinical and radiographic examination, has resumed all normal activity without pain, and has had no recurrence of her disease (Figures 10 and 11).