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51 year old with knee pain

Case Identification
Case ID Number: 
20090721KP
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 51 year old woman presents with left knee pain for 1 year. There has been no previous history of disease, injury, or exposure.

Radiological findings:: 
A lytic lesion is seen in the distal femur. Plain xrays, bone scan, and MRI are performed. Images are shown at left.
Laboratory results:: 
None of significance.
Pathology results:: 
Biopsy results are shown.
Special Features of this Case:: 
This large tumor presents a significant risk of pathological fracture. How should this be addressed?
Image Reference: 

52 year old man with left hip pain

Case Identification
Case ID Number: 
20120907BT
Periosteal Reaction: 
absent
Benign/Malignant: 
Malignant
Clinical case information
Case presentation: 

A 52 year old gentleman presents with a 6 month history of pain in his left lower side and left groin. He was admitted to hospital with pain and malaise.

Radiological findings:: 
Plain radiographs reveal a large osteolytic lesion in the left ilium directly superior to the left acetabulum. It measures approximately 5.4cm in its largest dimension. The lesion is ovoid in shape and relatively well-circumscribed. There is no surrounding sclerosis or periosteal reaction. The lesion is not expansile. CT of the pelvis show multiple smaller osteolytic lesions throughout the pelvis bilaterally. The left-sided lesion has not completely eroded the cortex. There are no fractures or protrusio femoris. There is a smaller osteolytic lesion in the right ilium but not in contact with the acetabulum on that side.
Laboratory results:: 
Blood tests: Hypercalcaemia, hyperuricaemia and reduced eGFR.
Differential Diagnosis: 
Multiple myeloma
Pathology results:: 
Pending
Treatment Options:: 
Chemotherapy. Fracture prophylaxis for the large left ileal osteoyltic lesion.

A 10 year old boy with pain in the left clavicle

Case Identification
Case ID Number: 
20100422LC
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 10 year old male had pain in the left shoulder for six months. An initial radiograph was interpreted as showing a non-displaced fracture. A slight fever was noticed which diminished after treatment with antibiotics.

Radiological findings:: 
The initial radiograph was interpreted as showing a non-displaced fracture. After the symptoms continued, a new radiograph was performed, which showed marked changes in the left clavicle.
Laboratory results:: 
On admission the patient's temperature ws 37.5°C. His WBC was 8.5 (4.5 - 9.5) with a normal differential. His electrolytes and liver function tests were normal, and the alkaline phosphatase was 738 (up to 740). The erythrocyte sedimentation rate was 52 (up to 15) and the protein C was 0.72 (up to 0.5). On examination his clavicle was enlarged and slightly tender. There were no neurovascular or cutaneous abnormalities. The motion of the left upper extremity was unimpaired.
Differential Diagnosis: 
Construct a differential diagnosis that has at least three entities; including a benign tumor, a malignant tumor, and a non-tumorous condition.
Image Reference: 

A 24 year old woman with pain off and on for years

Case Identification
Case ID Number: 
20141212KK
Periosteal Reaction: 
absent
Benign/Malignant: 
Benign
Clinical case information
Case presentation: 

This woman has had pain in her left hip off and on for several years. The pain was much worse during the summer of 2014 but recently improved. Her current Xrays and CT show a partially healed recent pathological fracture through a large bone tumor in her left femur.

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