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11 year old girl with left ankle sprain

Submitted by henry on Thu, 11/05/2009 - 17:05
Case Identification
Case ID Number: 
20091105ER
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This 11 year old girl presented to the local emergency room after she sprained her ankle in soccer. In your office 4 days later, she has local tenderness and swelling at the level of the joint line anterior to the distal part of the fibula.

Treatment for this patient consisted of 1) functional rehabilitation for the ankle sprain. 2) Observation with follow-up exams and radiographs for the tumor. See below for follow-up radiographs one year later and two years later. Click on the images for a better view.

Radiological findings:: 
The lesion is still present, but no growth or progression has occurred. Longitudinal growth of the bone has made the lesion seem to move away from the growth plate. The lesion shows no evidence of progression or aggressive behavior. It seems to have become smaller, but this is likely to be due to relative increase in size of the tibia due to continued growth. The lesion seems to have moved farther away from the growth plate. This lesion is likely to involute after skeletal maturity
Special Features of this Case:: 
In this case, it was felt that the tumor had no causal relationship with the sprained ankle, and that this lesion did not pose a threat of pathological fracture that was high enough to warrant surgical treatment. The patient was allowed to continue to play soccer and participate fully in gym class.
Image Reference: 
20091105ER
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32 year old man with pain in the knee

Submitted by henry on Thu, 07/09/2009 - 14:48
Case Identification
Case ID Number: 
20090709pk
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 32 year old man presented with pain in the lateral aspect of his knee for six weeks. He had no history of injury and was otherwise healthy. Radiographs and bone scan are shown at right.

Laboratory results:: 
Labs were normal.
Differential Diagnosis: 
The differential should include active bone tumors that are likely to occur around the knee of an adult. The possibilities include aneurysmal bone cyst, eosinophilic granuloma, giant cell tumor, lymphoma, and infection. Tumors and lesions that might occur in this setting but are less likely include hyperparathyroidism, osteosarcoma, Ewing's sarcoma, myeloma, lymphoma, angiosarcoma, adamantinoma, and fibrous dysplasia.
Image Reference: 
32 year old man with pain in the knee
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A 14 year old skater with knee pain

Submitted by henry on Tue, 07/28/2009 - 16:05
Case Identification
Case ID Number: 
20090728ZZ
Periosteal Reaction: 
present
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 14 year old skater has knee pain for 6 months.

Radiological findings:: 
See the images shown.
Special Features of this Case:: 
What is the most likely diagnosis?
Image Reference: 
A 14 year old skater with knee pain
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A 32 year old auto mechanic with multiple femur lesions

Submitted by henry on Tue, 11/17/2009 - 13:33
Case Identification
Case ID Number: 
20091117AM
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 35 year old auto mechanic whose wife had just had their first baby presented with severe pain in the distal femur. Subsequent work up showed multiple ipsilateral lesions. Pathology images from a similar lesion are shown.

Radiological findings:: 
The initial work-up revealed multiple lesions in both lower extremities, including a lesion in the mid-diaphysis of the ipsilateral tibia and two lesions in the contralateral femur. A CT scan of the chest showed pulmonary nodules.
Differential Diagnosis: 
metastatic adenocarcinoma, metastatic sarcoma, multiple myeloma (very rare in this age group)
Pathology results:: 
Images are from a similar tumor
Image Reference: 
A 32 year old auto mechanic with multiple femur lesions
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