Musculoskeletal Neoplastic Disease: The Daily PANCE Blueprint

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Musculoskeletal Neoplastic Disease: The Daily PANCE Blueprint

A 22-year-old male presents to the clinic due to left knee pain x 4 months. The pain is worse at night. He denies previous trauma. On exam, the knee is swollen and tender to palpation. You notice an antalgic gait as he walks down the hallway. Labs reveal elevated alkaline phosphatase. X-ray of the left knee shows a soft-tissue mass with a sunburst periosteal reaction, cortical bone erosion, and cortical thickening. Which of the following is the most likely diagnosis?

A. Chondrosarcoma
B. Ewing sarcoma
C. Multiple myeloma
D. Osteosarcoma
E. Rheumatoid arthritis

Answer and topic summary

The answer is D. Osteosarcoma

Osteosarcoma is a type of malignant bone tumor that arises from osteoblasts (mesenchymal stem cells) in the periosteum. It is one of the most common primary bone cancer. Clinical features include pain (which worsens at night), swelling, limping, decreased ROM, and fractures. The tumor is usually found in the metaphases of long bones, such as the femur or tibia. An x-ray may show the classic sunburst appearance or Codman triangle. MRI should be obtained. A biopsy is needed for diagnosis. Treatment is surgery with adjuvant polychemotherapy.

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