case_images: PMC10859149_01
case_images: Preoperative anteroposterior radiographic view of the pelvis. Rounded lucencies seen in the acetabulum and femoral head (both arrows)
case_images: cureus-0016-00000052171-i01.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i01.jpg
case_images: FIG1
case_images: X-rays showed osteolytic lesions both in the acetabulum and the femoral head (Figure 1).
case_images: Coronal STIR sequence. On the left fovea, there is a high-intensity, well-defined lesion (white arrow). STIR - Short tau inversion recovery
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case_images: PMC10859149_01_cureus-0016-00000052171-i02.jpg
case_images: FIG2
case_images: MRI scan of the pelvis showed a well-defined lesion of high intensity on the left fovea in the coronal short tau inversion recovery (STIR) sequence (Figure 2).
case_images: Sagittal PD with fat suppression sequence. Extension of the lesion within the right fovea (white arrow)
case_images: cureus-0016-00000052171-i03.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i03.jpg
case_images: FIG3
case_images: Sagittal proton density with fat suppression sequence displayed extension of the lesion within the right fovea (Figure 3).
case_images: Coronal STIR sequence MRI. Lesion (black open arrowhead) provokes intense bone oedema (asterisk), soft tissue oedema within the pelvis (black open arrow) as well as extension throughout the ligamentum teres towards the femoral head (black line). STIR - Short tau inversion recovery
case_images: cureus-0016-00000052171-i04.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i04.jpg
case_images: FIG4
case_images: Another coronal STIR sequence revealed that the lesion provoked intense bone oedema, soft tissue oedema within the pelvis, and extension throughout the ligamentum teres in the femoral head (Figure 4).
case_images: (a) Pre- and (b) post-contrast T1 with fat suppression images on axial plane. Vivid enhancement of the lesion (black dot line) is depicted
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case_images: PMC10859149_01_cureus-0016-00000052171-i05.jpg
case_images: FIG5
case_images: Pre- and post-contrast T1 with fat suppression images on the axial plane depicted vivid enhancement of the lesion (Figures 5a, 5b).
case_images: Coronal CT scan at the level of the lesion. Lucent area within the left fovea (black arrow)
case_images: cureus-0016-00000052171-i06.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i06.jpg
case_images: FIG6
case_images: More specifically, coronal (Figure 6) and axial (Figure 7) CT scans of the pelvis depicted a lucent area within the left fovea (black arrow).
case_images: Axial CT scan at the level of the lesion. Lucent area within the left fovea (black arrow)
case_images: cureus-0016-00000052171-i07.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i07.jpg
case_images: FIG7
case_images: More specifically, coronal (Figure 6) and axial (Figure 7) CT scans of the pelvis depicted a lucent area within the left fovea (black arrow).
case_images: Resected femoral head. Section of the femoral head demonstrating a deep central erosion (inferior hemisection).
case_images: cureus-0016-00000052171-i08.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i08.jpg
case_images: FIG8
case_images: II PS Cup Cluster Hole size 46 by United, the selected insert was U-Motion XPE Cup Liner (Highly Cross-linked Polyethylene) size 28 by United, the femoral stem used was Conformity Stem STD size 1 by United and Biolox Delta Ceramic 12/14 size 28 with +4 offset was the chosen femoral head. Intraoperatively, the lesion depicted in the scans was present from the acetabular fovea and migrating along the ligamentum teres, destroying the femoral head at the insertion of the ligamentum teres towards the middle of the femoral head (Figures 8-10).
case_images: Hemisections of the femoral head. Hemisections of the femoral head demonstrating pigmentation within the bone (superior hemisection)
case_images: cureus-0016-00000052171-i09.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i09.jpg
case_images: FIG9
case_images: II PS Cup Cluster Hole size 46 by United, the selected insert was U-Motion XPE Cup Liner (Highly Cross-linked Polyethylene) size 28 by United, the femoral stem used was Conformity Stem STD size 1 by United and Biolox Delta Ceramic 12/14 size 28 with +4 offset was the chosen femoral head. Intraoperatively, the lesion depicted in the scans was present from the acetabular fovea and migrating along the ligamentum teres, destroying the femoral head at the insertion of the ligamentum teres towards the middle of the femoral head (Figures 8-10).
case_images: Firm and sponge-like lesion extracted from the acetabulum. The removed lesion from the region of the acetabular fovea at the site of insertion of the ligamentum teres
case_images: cureus-0016-00000052171-i10.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i10.jpg
case_images: FIG10
case_images: II PS Cup Cluster Hole size 46 by United, the selected insert was U-Motion XPE Cup Liner (Highly Cross-linked Polyethylene) size 28 by United, the femoral stem used was Conformity Stem STD size 1 by United and Biolox Delta Ceramic 12/14 size 28 with +4 offset was the chosen femoral head. Intraoperatively, the lesion depicted in the scans was present from the acetabular fovea and migrating along the ligamentum teres, destroying the femoral head at the insertion of the ligamentum teres towards the middle of the femoral head (Figures 8-10).
case_images: Post-operative anteroposterior radiographic view of the left hip
case_images: cureus-0016-00000052171-i11.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i11.jpg
case_images: FIG11
case_images: Post-operative anteroposterior view of the left hip displayed excellent placement of both the femoral and acetabular components (Figure 11).
case_images: Histopathological examination. (a-c) Multiple tissue sections derived from the histopathological examination demonstrated fragments of a mesenchymal-type process composed of mostly spindle-shaped cells growing within a fibrous or myxomatous substrate. Among them, numerous giant osteoclastic type cells, as well as areas of haemorrhagic necrosis with hemosiderin deposits were frequently identified. Additionally, osteoid deposits were observed.
case_images: cureus-0016-00000052171-i12.jpg
case_images: PMC10859149_01_cureus-0016-00000052171-i12.jpg
case_images: FIG12