WASHINGTON — Although seemingly uncommon, osteosarcoma can masquerade as a sports-related harm, a doctor stated on the American Academy of Pediatrics annual assembly.
Actually, osteosarcomas account for 3% of all childhood cancers and are the most typical kind of bone most cancers, Haley Powell, DO, of Youngsters’s Hospital of Philadelphia, famous in a case collection of three teen sufferers.
Osteosarcoma primarily impacts the lengthy bones in adolescents. Preliminary signs, like joint ache, swelling, or limp, might be imprecise, which is why a radical analysis and acceptable workup is essential for analysis, Powell stated.
The case collection consisted of three sufferers: a 17-year-old feminine wakeboarder, a 17-year-old male theater pupil, and a 16-year-old feminine dancer.
The wakeboarder introduced with gradual knee and thigh ache that progressively worsened over the course of 8 weeks. The ache was largely at relaxation. A affected person examination didn’t reveal tenderness to palpation or restricted vary of movement, however there was slight weak spot from atrophy.
X-rays had been obtained for the affected person, and imaging confirmed that, within the distal femur, there was vital heterogeneity within the bone itself, “which is regarding for bone marrow involvement,” Powell stated. An MRI then confirmed a mass within the distal femur, additionally affecting the gentle tissue constructions across the humerus.
The teenager was handled by hematology/oncology companies “after seeing us in sports activities medication,” Powell stated, and she or he is now in remission.
The theater pupil reported worsening of knee and calf ache in addition to swelling for 4 weeks following an harm whereas performing choreography. The teenager’s ache was primarily with ambulation. An examination revealed ache over the medial joint line, a constructive lateral McMurray take a look at, restricted flexion and extension, and a constructive Apley’s take a look at.
On this case, the affected person’s x-ray was not extraordinarily regarding, Powell stated. “It’s important to actually be wanting arduous, however on the affected person’s proper leg on the medial condyle of the distal femur there’s some heterogeneity contained in the bone itself and possibly somewhat little bit of periosteal irregularity…as properly, however very troublesome to see.”
An MRI was already within the works due to meniscal issues, nevertheless the imaging revealed an enormous mass as an alternative. Importantly, this case “reveals that these can current as traumatic circumstances too,” she famous. “They’ll have a mechanism of harm, however they’re actually osteosarcoma.”
She stated the affected person had an amputation, and no metastasis.
The dancer reported gradual knee pan and limpness for six weeks that was worse with bending and strolling up stairs. However the teen additionally famous that her knee harm on a regular basis.
A 12 months previous to the presentation, the affected person’s contralateral knee ache was identified as patellofemoral syndrome. She had tenderness to palpation over the lateral joint line and posterior side of the knee, restricted flexion and extension, and constructive patellar grind. There was no palpable mass.
Notably, regardless of the latter commentary, on the affected person’s x-ray, Powell famous there was a “very apparent mass.” Imaging revealed a bony mass on the posterior side of the distal femur.
The affected person had a number of lung relapses, she stated, and handed away on the age of 25 earlier this 12 months.
Powell identified that it was vital to notice that, although all three sufferers introduced to a sports activities medication clinic, their underlying etiology was oncologic.
Many athletes first report back to their main care supplier looking for an preliminary analysis and subsequent steerage, she famous. Considerably, in all three circumstances, the adolescents had worsening ache that lasted 4 to eight weeks and that occurred at relaxation.
It is vital to “remember the affected person’s chronicity of ache, the placement of their ache, their age,” Powell identified. These components play a task in figuring out the urgency of an x-ray, as an example.
“We simply needed to carry the popularity, the nuances of osteosarcomas, and the way they’ll current to any scientific setting, actually,” she stated.
Disclosures
Powell reported no conflicts of curiosity.
Main Supply
American Academy of Pediatrics
Supply Reference: Powell H and Davis E “Osteosarcoma masquerading as sports-related harm: A case collection” AAP 2023.
