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Difficulty: HardOrthopedic Surgery

Match each clinical and radiographic vignette with the most likely primary bone tumor diagnosis.

  • A 15-year-old boy presents with progressive distal thigh pain. Labs show elevated alkaline phosphatase. Radiographs reveal a destructive, mixed lytic and blastic metaphyseal lesion with elevation of the periosteum at the margins.Osteosarcoma
  • A 13-year-old boy presents with localized mid-thigh pain, low-grade fever, and leukocytosis. Radiographs show a permeative diaphyseal lesion with concentric, lamellated layers of reactive bone formation.Ewing sarcoma
  • A 30-year-old woman presents with worsening knee pain with weight-bearing. Radiographs show a purely osteolytic, eccentric lesion extending into the proximal tibial epiphysis without a sclerotic rim.Giant cell tumor of bone
  • A 22-year-old man presents with dull thigh pain that wakes him from sleep but is completely relieved by ibuprofen. Radiographs demonstrate a small, circumscribed radiolucent nidus surrounded by dense reactive cortical sclerosis.Osteoid osteoma

Answer

The correct pairings match each specific bone tumor presentation with its classic demographic, anatomical location, and radiographic features.
Each tumor has a distinct predilection for patient age and long bone anatomy. Osteosarcoma arises in the metaphysis of teens; Ewing sarcoma in the diaphysis of children/teens; Giant cell tumors in the epiphysis of adults; and Osteoid osteomas present with NSAID-responsive night pain and a characteristic nidus.

Step-by-Step Solution

1
Analyze the first vignette for demographic and radiographic clues.
Identified adolescent age, metaphyseal location, mixed lytic/blastic pattern, and elevated periosteum (Codman triangle), which points to Osteosarcoma.
Osteosarcoma is the most common primary malignant bone tumor in adolescents and classically occurs in the metaphysis of long bones.
2
Analyze the second vignette focusing on systemic symptoms and location.
Identified diaphyseal location, 'onion-skin' periosteal reaction, and constitutional symptoms mimicking osteomyelitis, indicating Ewing sarcoma.
Ewing sarcoma often presents with fever and leukocytosis and is classically found in the diaphysis of long bones.
3
Evaluate the third vignette for age and specific bone region.
Identified an adult patient (post-physeal closure) with an epiphyseal, eccentric, lytic lesion, which corresponds to a Giant cell tumor of bone.
Giant cell tumors typically arise in the epiphysis of long bones in young adults between 20 and 40 years of age.
4
Review the fourth vignette for classic symptom descriptors.
Identified nocturnal pain completely relieved by NSAIDs and a radiolucent nidus with surrounding sclerosis, confirming Osteoid osteoma.
Prostaglandin-producing osteoid osteomas cause night pain that responds dramatically to prostaglandin inhibitors like ibuprofen.

Key Concept

Primary Bone Tumors: Demographics, Anatomical Location, and Radiographic Features
Estimated Time:2m 0s
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Orthopedic Surgery

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