Clinical Cases

This 70 year old patient has a right distal femoral fibrosarcoma in the setting of Paget's disease (post-Paget sarcoma). Distal femoral resection and replacement is performed.

A very pleasant 70 year old woman who has Padget's disease, a history of liver failure, and right knee pain with a worrisome mass in the distal femur.

This 42 year old woman is quite heavy. She has noticed a gradually enlarging swelling in the front of her right ankle.

A 78 year old man has a slowly growing, slightly painful, palpable nodular mass in the TMT joint of the 1st ray.

The patient is 59, and she has a 40 pack years smoking history. Seven years ago, she had a painful kidney removed, and a tumor was found in the kidney.

On examination, the left upper extremity is in a sling. The patient cannot really move the arm outside of the sling. No mass is felt around the shoulder at all, and there is no swelling of the affected bone.

This patient has had pelvic metastasis from thyroid carcinoma for 6 years. He has had multiple episodes of radiation therapy, with the total dose to the left hemipelvis and of the right hemipelvis in excess of 10,000 centigray.

This 60-year-old right handed woman has had gradual onset of pain in the right elbow. X-rays show a destructive bone lesion in the distal humerus. Further radiographic evaluation has shown that there is a 6.9 cm mass in the lower pole of the left kidney. It has a heterogeneous appearance consistent with renal cell carcinoma. The bone scan shows multiple areas of abnormality, including two lesions in the skull.

This very pleasant 55-year-old woman has a lump in the left breast and pain in the left hip. She found the breast mass 1 year ago, and it has gotten larger. She first noticed gradually increasing pain in the left groin 8 or 9 months ago. Now, the patient cannot walk without crutches. She has extreme pain with certain activities, and is taking large doses of narcotic pain medicines.

The patient is 66, he has a slightly painful swelling on the lateral aspect of the right shoulder for at least one year. Now, the mass has become quite large, and there is pain in the right shoulder.
The patient has not been caring for himself well and has not seen a doctor or a dentist in quite some time. However, has not had any fevers or chills or systemic symptoms. There has been no unplanned weight loss.

This man is 32 and works as a mechanical engineer. He is here because of painful ankles. His grandfather, grandmother, and two brothers also had similar problems. He has had several surgeries for bone problems, including a shoulder on the right when he was 12, surgeries on both tibias when he was 16, a surgery on his foot when he was 25 and another surgery on the knee when he was 26.

A 40 year old male presents with a mass that was found on an MRI done 17+ months ago for peroneal tendon tendonitis. A new MRI showed that the mass had gotten much larger.

Patient has a mass he thinks might be a varicose vein on the anterior surface of his left leg for several years.

This patient is 54, she presents with nausea, fatigue, lethargy, and a bone lesion in the right femur. On presentation, she was anemic, hypercalcemic, and hyperkalemic. She had had right knee pain for approximately 2 weeks and was taking frequent large doses of ibuprofen for pain control.

The patient is 63. She has pain in the right knee which has been increasing gradually for the past 4 or 5 months. It is now very intense. Initial x-rays (shown) were unimpressive. Later a lesion in the right distal femur was discovered. Because of the patient's medical history a large number of diagnostic possibilities exist.

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.

A 32 year old patient had a giant cell tumor in her right proximal humerus. The AP radiograph and a radiograph taken after the biopsy are shown. Wide resection of the tumor was chosen because the lesion had destroyed too much of the bone and could not be treated with conventional curettage and packing with cement or bone graft.

The patient a delightful 82-year-old woman, who is seen after referral from Dr. P, after a bone lesion in the base of the fourth metatarsal was found.

The patient has a history of pain in the hip that dates back about two months. The pain became gradually worse and he had some small episodes of exacerbation. Recently he began using crutches. Then, he had another episode of a slight twisting injury with dramatic increase in the pain and was found to have a fracture.

A woman presents with knee pain, instability, a large soft tissue mass in the posterior knee, and multiple small skin tumors

The patient is a very pleasant 22-year-old woman who is generally healthy, she recently graduated college and was previously a ballet dancer. She has no serious medical problems and there is no history of injury to the area in question.