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unknown tumor - all other

32 year old man with pain in the knee

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.

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: 

A 10 year old girl who fell during soccer

Case Identification
Case ID Number: 
20090727GF
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

An ten year old girl presented to her primary care physician with pain after a fall in a soccer game. The initial radiograph is shown at left as the main image.

Radiological findings:: 
Two weeks later she was seen in the orthopedic oncology clinic. New radiographs were taken, shown at left. A followup was arranged for four weeks later. The third radiograph is shown at left.

A 36 year old woman with metatarsal lesion

Case Identification
Case ID Number: 
20091110FP
Periosteal Reaction: 
absent
Benign/Malignant: 
Benign
Clinical case information
Case presentation: 

The patient is a very pleasant 36 year old woman who has noticed a pain in the foot since approximately one month ago.

Radiological findings:: 
Plain radiographs, a bone scan, and MRI are assessed. A lytic, slightly multilocular lesion in the midportion of the second ray is seen. The dimensions are approximately 2 0.5 cm x 1 cm. It seems to extend through one cortex. It does not have any matrix mineralization. It is non-expansile and there is no periosteal reaction.The bone scan shows that the lesion has abnormally increased uptake. The MRI shows a lesion in the above-named location that has bright signal on T2 weighted images. There is destruction of one cortex. There is some surrounding edema.
Further Work Up Needed:: 
This lesion needs to be characterized by biopsy. Possible choices include chondromyxoid fibroma, or other benign lesion. It does not have malignant appearance. Nevertheless, malignancy is still a possibility.
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