Clinical Cases

FJ is a 32-year-old father of two small children who presented to the local hospital in Nicaragua with a painful tumor in the left distal femur. A biopsy was made and the diagnosis was giant cell tumor. The patient was told that he needed an amputation, but he refused.

This healthy male was treated for an expansile lesion of the left humeral diaphysis at age 13. At age 25, pain recurred, and xrays show a large new lesion with weakening of the bone.

This 54 year old professional male is very active. He has had a mass on both feet for 20 years or more. The mass on the left has always been larger and is now problematic because of pain and swelling after activities.

This 44 year old woman has a 3.5 by 4 cm mass on the lateral distal portion of the foot. Can a definite diagnosis be made right away in the clinic, without a complicated and expensive work up? Read on.

This boy just had his 11th birthday, and he has pain in the left arm above the elbow, with pain at night, mild improvement with various pain medications, and no history of injury, fevers, or previous illness of any kind. A biopsy has been done.

This 69 year old male has a mass on the lateral aspect of the great toe for at least 10 years. The mass has now gotten large enough to be troublesome. The lesion is not painful. It is fleshly, and moderately soft.

This 58 year old man has right knee pain, and a lesion in the anterior part of the right tibia near the tibial tubercle.

This boy just had his 11th birthday, and he has pain in the left arm above the elbow, with pain at night, mild improvement with various pain medications, and no history of injury, fevers, or previous illness of any kind.

Female Caucasian , 59 y.o Pain in the left shoulder the last 3 years.
Aggravation the last 6 months, but no night pain.

This young adult has a massive femoral tumor. No further information is available. However, the appearance is very distinctive and may be diagnostic.

This delightful 90-year-old woman has pain in the right foot, in the midfoot at the base of the second and third metatarsals. There is a lesion on the x-rays and on the MRI in that area. The patient has a history of nephrectomy for renal cell carcinoma 6 years ago.

The patient is a 55 y.o female with pain on the base of the 1st metatarsal. She has difficulty on weight bearing leading to an antalgic gait.

This active and fit 36 year old woman has been practicing mixed martial arts and kickboxing. She says her right foot has been "thick" and swollen for about 6 months.

This generally healthy 36-year-old woman has calcifications in the tissues plantar to the first metatarsal. There is no history of injury.

This healthy and active 56 year old woman has a painless lesion in the distal tibia. The lesion was discovered on an MRI that was performed for unrelated foot pain. The lesion is totally invisible on the xray, but easily seen on the MRI.

The patient is a 62-year-old woman who is seen because of a mass in the right shoulder. She states that her symptoms began approximately two years ago, with stiffness. She had limited motion and was told that she might have a frozen shoulder.

The patient is a very pleasant 86 y/o woman. She says there is absolutely no pain in the thigh She denies any weakness in the right leg. She feels fine, and her appetitie is good, but she has lost 15 lbs in the past few months. Examination of the thigh shows normal mobility of the hip and normal mobility of the knee, and the strength in the two legs is roughly equal.

The patient has a painful skin lesion on the dorsolateral surface of the left second toe, adjacent to the base of the left second toenail. The lesion does not have any visible pigmentation. It has a raised, red, scaly appearance with the overlying skin coming off in small flakes. It has been present at least one year, with slow growth.

This 88 year old woman has dementia, left ankle pain, and a lesion in the left talus. There was treatment for two different tumors approximately 10 years ago, but further details are not available. The local exam shows swelling and tenderness, but no redness, no old incisions or scars,and moderate tenderness generalized around the ankle. The patient is afebrile.

This 18 year old male has pain in the shin for 4 months. The pain is exacerbated by his ongoing training for the "iron man" competition. Examination of the tibia shows there slight point tenderness, but no mass or swelling. No regional lymphadenopathy. Knee exam is normal.