A 13 year old boy who has sustained a left lateral knee contusion while playing football, followed 2 weeks later by a mild knee blow inflicted bu a school bully. X-rays revealed an osteogenic sarcoma. This case illustrated the importence of the affected extremity when the diagnosis in doubt.
The possibilites in injury are, a lateral collateral ligament strain or tear, physeal plate fracture, or a possible ACL,PCL, or lateral maniscus tear. Other possibilities include, discoid miniscus, patellofemoral disorder in a dislocation, medial patellar retinaculum symptoms, plica syndrome, and iliotibial band friction syndrome.
Test results, by X-ray, demonstrate a permative bone lesion on the lateral aspect of the distal femur and a Codman's triangle superiorly-a trianglular area where the posterium, elevated by the bone tumor, rejoins the cortex of a normal bone. A CT scan showed a permative lesion of the postrolateral aspect if the distal femur extending into the soft tissue and raising the cortex laterally. A bone scan was normal, with the eception of greatly increased uptaske at the distal femur.
The differential diagnosis is a malignant tumor, or ostiogenic sarcoma. The reason for the differential diagnosis is the athletes sex and age. This usually occurs in males from the ages from 10-20. These tumors may be secondary to trama or exposure to radiation. This tumor occurs in the metaphyseal area of lomg bones- the sight of the patients problem. Upper femur and proximal tibia, and the hemerus. The patient will experiance pain, swelling, and weight loss. In this case there was none.
The doctors concideres parostial sarcoma. This condition usually occurs in people in thier 40's. Usually there is seperation of the tumor from the bone, in this patient there was none. They also concidered Edwing's sarcoma. This condition usually affects people between the ages of 10-30 and found in long bones. There is pain, increases sedimentation, and a possilbe fracture. There is also onion skining, but this was not evident in this patient. They also concidered a giant cell tumor-a benign tumor that can become malignant. It rarley occurs before the age of 20.
Other options include: -fibrosarcoma -metastatic lesions -Reticulum cell sarcoma, synovial sarcoma, and eosinophilic granuloma. These don't need to be concidered.
Chemotherepy was begun and 6 weeks after the chemotherepy started, the patients left leg was amputated above the knee. This was followed by postoperative chemotherepy.