case_images: PMC518976_01
case_images: MRI at diagnosis (case one).
case_images: 1471-2407-4-57-1.jpg
case_images: PMC518976_01_1471-2407-4-57-1.jpg
case_images: F1
case_images: Nearly one year later (April 1996) the family sought a second opinion and an MR study was ordered that revealed a cystic structure [Figure 1].
case_images: Afterloading catheters and dosimetry (case one).
case_images: 1471-2407-4-57-2.jpg
case_images: PMC518976_01_1471-2407-4-57-2.jpg
case_images: F2
case_images: Eleven afterloading catheters were placed in a parallel array to cover the tumor bed [Figure 2].
case_images: Treatment ports and dosimetry (3D).
case_images: 1471-2407-4-57-3.jpg
case_images: PMC518976_01_1471-2407-4-57-3.jpg
case_images: F3
case_images: Three weeks later, the patient began external beam irradiation at 180 cGy per day and received a total external beam dose of 4860 cGy using 6 MV photons with treatment delivered in a parallel-opposed beam arrangement using a CT based treatment plan [Figure 3].
case_images: Serial plain films (case one).
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case_images: PMC518976_01_1471-2407-4-57-4.jpg
case_images: F4
case_images: More than four and a half years after initiating treatment (August 2001) [Figure 4], x-ray scanogram revealed estimated lengths of 49.0 cm and 46.5 cm for his right and left femora respectively, and 40.7 cm and 37.0 cm for his right and left tibiae respectively [Figure 5].
case_images: Scanogram 4/2001 (case one).
case_images: 1471-2407-4-57-5.jpg
case_images: PMC518976_01_1471-2407-4-57-5.jpg
case_images: F5
case_images: More than four and a half years after initiating treatment (August 2001) [Figure 4], x-ray scanogram revealed estimated lengths of 49.0 cm and 46.5 cm for his right and left femora respectively, and 40.7 cm and 37.0 cm for his right and left tibiae respectively [Figure 5].
case_images: Pre-Op MR and photograph (case one).
case_images: 1471-2407-4-57-6.jpg
case_images: PMC518976_01_1471-2407-4-57-6.jpg
case_images: F6
case_images: He was taken to surgery five years after the initiation of definitive therapy (December 2001) [Figure 6] for a panepiphysiodesis of the right leg.
case_images: PMC518976_02
case_images: MR Imaging (case two).
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case_images: F7
case_images: Plain films were normal and an MR was ordered that revealed an apparent meniscal cyst in the lateral aspect of the left knee [Figure 7].
case_images: Brachytherapy films and dosimetry.
case_images: 1471-2407-4-57-8.jpg
case_images: PMC518976_02_1471-2407-4-57-8.jpg
case_images: F8
case_images: Radio-opaque clips were placed to delineate the tumor bed and assist in brachytherapy planning [Figure 8].
case_images: External Beam films and dosimetry.
case_images: 1471-2407-4-57-9.jpg
case_images: PMC518976_02_1471-2407-4-57-9.jpg
case_images: F9
case_images: Two weeks later the patient began external beam irradiation at 180 cGy/day and received a course of treatment and total external beam dose of 5040 cGy using 6 MV photons with treatment delivered with two beams using a CT based treatment plan [Figure 9].
case_images: MR Imaging and photography.
case_images: 1471-2407-4-57-10.jpg
case_images: PMC518976_02_1471-2407-4-57-10.jpg
case_images: F10
case_images: An MR study was reviewed by Orthopedic Surgery and was noted to show growth arrest laterally and predominantly involving the distal femoral physis [Figure 10].