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unknown tumor - fibrous

50 year old tennis player with pain in the knee .

Case Identification
Case ID Number: 
20091117AD
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient is a very pleasant woman who is an active tennis player and 50 years of age. She has had aching pain in the left knee and a radiograph revealed a bone lesion in the proximal tibia. The patient is seen at the request of her orthopedic surgeon.

Radiological findings:: 
The patient is generally healthy. She is currently taking no medicines. There is no family history of bone lesions or bone tumors. On detailed examination, the patient is in no acute distress, and is oriented to time, place, and person. Examination of the right knee shows normal appearance. There is no effusion. There is no erythema or swelling, no ecchymosis or bruising noted. The alignment of the knee is normal. The range of motion is full. In the proximal tibia there is no mass palpable. There is no tenderness over the proximal bone. There is no erythema or sign of inflammation. There is no popliteal adenopathy, no inguinal adenopathy, and no cervical adenopathy. The skin is normal and there is no cafe au lait spots.

A 14 year old girl with a pain in her knee for 2 months

Case Identification
Case ID Number: 
20091106AA
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 14 year old girl complained of a vague aching pain in her knee for two months. Exam showed a firm, slightly tender mass palpable on the surface of the posterior femur in the lateral popliteal fossa and no other findings. She had no night pain, no definite benefit from aspirin, no history of injury and was otherwise in excellent health. Laboratory exams were unremarkable.

Radiological findings:: 
On the plain radiographs, there is a vague sclerotic area along the posterior lateral side of the femur. The lesion is on the surface of the bone. The differential should include the list of surface lesions that occur in this location and age: Periosteal osteosarcoma, parosteal osteosarcoma, osteochondroma, osteoid osteoma, myositis ossificans, and metaphyseal fibrous defect (tug lesion).
Differential Diagnosis: 
The differential diagnosis should be constructed from the plain radiographs and the patient's history. Once a list of possibilities is assembled, the CT and MRI results are examined and the probability of each diagnosis is increased or decreased. The final result should be a list of two or three possibilities. Beware of the temptation to start listing possible diagnoses based on the MRI, the bone scan, or the CT, since these modalities may "overcall" the lesion. The lesion has no aggressive features by radiographic criteria. The lesion does have a small round lucent area seen on the CT that might be interpreted as a nidus, leading to the possibility of osteoid osteoma, but the patient does not have the expected pain pattern. The reformatted CT and the lateral MRI are very helpful, since they show the how the lateral head of the gastrocnemius is inserting on the posterior femur right at the site of the lesion. This, the location, and the patient's age make the diagnosis clear.
Image Reference: 

A 22 year old woman with pain in the left ischium for about two year

Case Identification
Case ID Number: 
20091117AK
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

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.

Radiological findings:: 
The patient has had pain in the left ischium for about two years which has not been getting worse, but not been getting better. She has no problems except for when sitting, and has difficulty because the left hip is sore when sitting Examination of the area which is the left initial tuberosity reveals no tenderness and no mass. Comparison with the opposite side reveals no side-to-side differences.

A tibia tumor in an 8 year old boy

Case Identification
Case ID Number: 
20090722TT
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This active young man is 8 1/2. Five days ago, he fell, injuring his left leg on a rock. He started having pain. And x-ray was made, and lesion is found in the mid tibia near the site of the pain.

Radiological findings:: 
On closer questioning, the child seems to have had pain in the area for a few weeks or longer. Precisely when the pain began is difficult to pin down. There is no history of injury when the pain actually began a few weeks ago. There are no contributing past medical, surgical, social, or familial factors. On examination, the patient is afebrile, and in no acute distress. There is limping, antalgic gait and station. Examination of the leg shows the area is slightly warm and slightly tender. There is no redness. There is no irritability of the knee or of the ankle. The neurologic status of the foot and the pulse in the foot are normal. The hip range of motion is normal. There is no regional or central lymphadenopathy. I instructed the father to give the patient Naprosyn, and monitor his response. The patient had minimal relief of pain from the Naprosyn. Biopsy was performed and histopathology is shown. Radiographs show a lesion in the mid tibia, within the medullary cavity.There is slight expansion of the cortex, with thinning. There appears to be a faintly calcified matrix. A bone scan shows abnormal uptake, and a CT scan shows the lesion in better detail.
Laboratory results:: 
The laboratory exam shows a mild elevation in the sedimentation rate and the C reactive protein.
Pathology results:: 
See images.
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