A 60-year-old man, with no relevant medical history, underwent total hip arthroplasty at another institution for left hip pain that was interpreted as hip arthritis (Figs. 1-A and 1-B). During the surgical procedure, the orthopaedic surgeon noted an abnormal mass in the medial aspect of the proximal part of the left femur. At this point, the femoral neck osteotomy had already been performed and the acetabular cup had been implanted. In addition, no mass was visualized in the femoral canal. After identification of the proximal femoral mass, a biopsy was obtained. No frozen section was performed, and the decision was made to finish the total hip replacement (THR) (Fig. 2). After the patient was discharged, a referral was made to our institution.
The patient was admitted to our institution, where bone scintigraphy, hip computed tomography (CT) (Fig. 3-A), and hip magnetic resonance imaging (MRI) (Fig. 3-B) were obtained. No evidence of distant disease was discovered. A wide proximal femoral resection was performed with reconstruction (Fig. 4) with a proximal femoral arthroplasty, maintaining the original acetabular cup (Fig. 5).
The surgical specimen was submitted to pathology (Figs. 6-A and 6-B).
What is the diagnosis?
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