A 13-Year-Old Boy With Recurrent Lower Leg Pain

Prasenjit Das, MD, MBBS; Elanthenral Sigamani, MD


June 13, 2017

Physical Examination and Workup

The patient is a well-built, athletic-appearing boy. His blood pressure is 116/78 mm Hg, his pulse rate is 68 beats/min, and his body temperature is measured at 98.2°F during his first visit to the orthopedic outpatient department.

Examination of the leg reveals severe localized tenderness over the lower left tibial prominence, with soft-tissue swelling and edema. The overlying skin shows mild reddening as well as increased local temperature. The cardiovascular, respiratory, and gastrointestinal organs examined are clinically within normal physiologic limits.

The hematologic and biochemical parameters examined are within normal physiologic limits. The erythrocyte sedimentation rate and C-reactive protein levels are also within normal physiologic limits. The hematologic examination shows a hemoglobin level of 11 g/dL, total leukocyte count of 13,000 ×103 cells/μL, and platelet count of 180 ×103 cells/μL.

Anteroposterior chest radiography does not show any localized lesions in the lungs. No lymphadenopathy is detected. Anteroposterior-view and lateral-view radiography of the lower left end of the tibia show an eccentrically located, well-demarcated, lytic, bubbly, lobulated lesion in the metaphyseal region (Figure 1). A periosteal reaction is not seen. Focal epiphyseal extension is also noted (Figure 2). A subtle fracture is identified at the lateral margin of the lower tibia (Figures 1 and 2). Axial T2-weighted MRI also shows a hyperintense, solid, lobulated growth (Figure 3).

Figure 1.

Figure 2.

Figure 3.

A biopsy is performed, but unfortunately the yield is scant and is composed only of fibrous tissue and traces of cartilaginous material. Curetting and bone grafting is performed, with the corresponding histopathologic examination demonstrating a characteristic biphasic lesion (Figure 4). A frozen section prepared from the curettage shows a possible benign cartilaginous tumor.

Figure 4.


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