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unknown tumor - bone

11 year old girl with left ankle sprain

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.
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12 year old boy with right elbow pain and stiffness

Case Identification
Case ID Number: 
20091105AR
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 12 year old boy was referred from outside center following a three week history of worsening right elbow pain.In addition to the pain, the patient also had significantly reduced range of motion, and when seen in the clinic had only 20 degree range of active motion. His elbow is remarkably tender with significant effusion also.

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A 27 year old man with a 3 month history of swelling of the dorsum of the foot

Case Identification
Case ID Number: 
20091105BR
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This 27 year old man presented with a 3 month history of swelling of the dorsum of the foot. He was healthy, working full time, and afebrile. Exam of the right foot showed a mildly tender, diffuse swelling of the area near the talus and navicular, without fluctuance or erythema. Laboratory exam was significant for a normal white cell count and an ESR of 25.

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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.
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