Thigh
Mass in Middle School Football Player
Blair DF, Peyton CC, Freed SD: Wenatchee High School, Wenatchee, Washington
An 11 year-old white male reported for a team physical prior to
his football season with a large mass in his thigh. At the age of four, he
indicated he had received a contusion to the distal femoral region and a small
mass was noted at that time. Follow-up radiographs showed an abnormality
that was thought to be a post-traumatic osteal myositis. Over the past
seven years, the mass had remained rather constant in size. However, an increase in the size
of the mass was noted six to eight weeks prior to its discovery at physical
night. The athlete also noted that the growth of the mass during this period had
been exponential.
During a basic musculoskeletal screening by a certified athletic
trainer, a sizeable mass was found in the anteromedial distal thigh. The
deformity was visible even though his pants. He exhibited slight
tenderness over involved area. The athlete demonstrated no difficulty
with running or sports activities. Range of motion tests established relatively
normal levels of flexibility and mobility. He had no other bone pain and no
systemic symptoms.
1. Myositis ossificans
2. Osteosarcoma
3. Chondrosarcoma
4. Osteochondroma
5. Chondroblastoma
6. Endochondroma
7. Giant cell tumor
8. Myeloma
X-rays revealed an ossified, irregularly shaped mass. The
mass appeared to be coliform-shaped and about six by eight centimeters in
size. The results of the CBC returned with normal blood chemistry
levels. A bone scan indicated an increased uptake in left femur and no
other bone abnormalities. The CT scan of the brain did not reveal any
acute hemorrhaging or abnormal areas of enhancement.
The initial evaluation occurred on August 11, 2003 during
physicals. The following day, the
physician who had evaluated him the night before ordered a battery of tests
including enhanced CT, bone scan, and laboratory work. He was then immediately referred to a
childrenÕs orthopedic hospital for additional tests and a surgical
consultation. Upon reviewing the
imaging, it was determined that the mass was entangled with the bone. A calcium deposit underneath the cap of
the tumor was also concerning for the surgeons. Surgical excision of the mass was performed on September 4,
2003. Upon excision, it was determined that the mass was an osteochondroma, a
benign bone tumor generally occurring during periods skeletal growth between
the ages of 10 and 25 years, most typically during adolescence.
Post-surgically, the athlete released from the hospital the following day and
carried out a regular home rehabilitation program. He was cleared to play
basketball on November 10, 2003.
He has greatly exceeded the physicianÕs expectations with his rapid
recovery.
The extended course
of this bony mass was very unusual.
This athlete carried a mass for seven years before this benign tumor
started to grow. The speed of
growth of this tumor was also remarkable.
It had significantly increased in size even in the short three-week
period from initial diagnosis to surgical removal. It is important to carefully recognize and identify any
masses or lumps in soft tissue (which might be confused with a myositis
ossificans) to rule out the possibility of tumors early in the evaluative
process.