case_images: PMC11003218_01
case_images: (a) Preoperative plain radiographs reveal multiple eccentric, predominantly lytic lesions of the tibia shaft with well-defined transition zones and solid periosteal reactions, without destruction, (b) postoperative radiographs 6 years after show distal extension of osteolytic lesions to the epiphysis and subarticular zone, and (c) gross appearance of the tumorous lesion after amputation. The tumor presents as a yellowish-gray, cheesy and gritty mass with areas of necrosis and hemorrhage that involve the cortex and expand into the medulla. The lesion reaches the distal portion of the tibia.
case_images: 10.1177_2632010X241240391-fig1.jpg
case_images: PMC11003218_01_10.1177_2632010X241240391-fig1.jpg
case_images: fig1-2632010X241240391
case_images: Six years after, radiographs show distal extension of the osteolytic lesions to the subarticular zone (Figure 1a and b).
case_images: Histological and immunohistochemical (pancytokeratin (AE1/AE3), p63, podoplanin (D2-40)) results of sections of the same lesion taken at different time intervals (magnification 100x). Classical adamantinoma histomorphology was detected in the primary and last specimens, while the same lesion in the first recurrence showed fibrous-dysplasia like features. Independently of morphology, all sections were positive for adamantinoma markers.
case_images: 10.1177_2632010X241240391-fig2.jpg
case_images: PMC11003218_01_10.1177_2632010X241240391-fig2.jpg
case_images: fig2-2632010X241240391
case_images: The first histological analysis demonstrates a classic AD (features of tubular epithelial cells), positive for pancytokeratin and vimentin, in a well-vascularized stroma (Figure 2). The recurrent lesion was characterized by spindle, fibroblast-like cells with uniform, oval nuclei, along with small and disconnected bone trabecule without osteoblastic rimming (Figures 2 and 3a). The results of the analysis are shown in Table 2 and Figure 2.
case_images: (a) Fibrous dysplasia-like features of the tumor section from the first recurrence and (b) osteofibrous dysplasia-like features (with clear osteoblastic rimming) detected in the tumor section from the resected tumor (magnification 200x).
case_images: 10.1177_2632010X241240391-fig3.jpg
case_images: PMC11003218_01_10.1177_2632010X241240391-fig3.jpg
case_images: fig3-2632010X241240391
case_images: The recurrent lesion was characterized by spindle, fibroblast-like cells with uniform, oval nuclei, along with small and disconnected bone trabecule without osteoblastic rimming (Figures 2 and 3a).