This revealed a large, lobulated mass centered within the patella but extending into the joint space Fig. MRI of the knee shows extensive tumor arrowheads in the soft tissues along the ventral aspect of the distal femur, within the joint space, and involving the patella.
The tumor showed heterogeneous enhancement following contrast administration. Sagittal T1-weighted MR of the knee. Sagittal T2-weighted, fat-saturated MR of the knee. Axial T1-weighted, fat-saturated MR of the knee. Axial T1-weighted, fat-saturated MR of the knee after administration of intravenous contrast material. Needle biopsy revealed metastatic adenocarcinoma Figure 2 , Figure 3. Resection specimen.
The specimen consists of complete resection of the knee joint distal femur, proximal tibia, patella. Extensive tumor in the soft tissues resulted in formation of intestinal-like glands. Low-power keratin stain is positive for epithelial material, consistent with adenocarcinoma. The patient underwent resection of the distal right femur, proximal tibia, and knee joint followed by reconstruction with distal femoral replacement and hinge knee arthroplasty.
During resection, it was noted that the patella was found to be completely destroyed by tumor, and there was spread of the tumor to the retinaculum of the knee joint. The patient's recovery was uneventful. Knee pain is a common ailment affecting the general population.
Primary-care, emergency, and sports-medicine physicians are faced with deciphering the myriad causes of knee pain and swelling. Most cases of knee pain are due to altered biomechanics and inflammatory etiologies and can be treated conservatively. In cases of failed conservative management, advanced imaging and reconstructive surgery are often indicated. Fortunately, malignancy is a rare cause of knee pain; specifically, malignancies involving the patella are uncommon and are usually due to primary bone tumors such as osteosarcoma 1.
Metastatic disease involving the patella is even less common than primary malignant tumors 4. A plausible explanation for the relative scarcity of patellar metastases stems from the patella's being a sesamoid bone with a poor blood supply and distal location 5.
Sore Throat. Strep Throat. Home Diseases and Conditions Osteosarcoma. Table of Contents. What is osteosarcoma? What causes osteosarcoma? How is osteosarcoma diagnosed? There are a number of tests your doctor may use to determine if your child has osteosarcoma. Physical exam: The doctor will check for general signs of health as well as examine the place around the swelling, lump, or break.
The doctor will also ask about any previous health conditions or medical treatments. X-ray: An X-ray is usually the first imaging test your doctor will order. If there is a tumor, it will usually show up on the X-ray. MRI scans take pictures that help your doctor see if the tumor has destroyed any of the bone. A CT scan is useful to look at the chest and belly to see if the disease has spread. Before a CT scan, the doctor may inject or ask you to swallow a special kind of dye.
The dye helps the organs or tissues show up more clearly on the scan. Biopsy: A biopsy is important because other malignant cancerous tumors and some infections can look like osteosarcoma on an X-ray. For the biopsy, a doctor with training in the treatment of bone cancer takes a piece of the tumor from the bone.
The doctor can sometimes do the biopsy with a needle. Other times, he or she will need to make an incision a cut in the skin. The piece of tissue the doctor takes is looked at under a microscope to see if the tumor is an osteosarcoma.
Types of Cancer. Bone Cancer Sarcoma of Bone Guide. Medical Illustrations. Risk Factors. Symptoms and Signs. Stages and Grades. Types of Treatment. About Clinical Trials. Latest Research. Coping with Treatment. Follow-Up Care. Accessed Dec. Bone cancer. Fort Washington, Pa. Goldman L, et al. Malignant tumors of bone, sarcomas and other soft tissue neoplasms.
In: Goldman-Cecil Medicine. Philadelphia, Pa. Questions and answers about bone cancer. Centers for Disease Control and Prevention. Ferri FF. Bone tumor, primary malignant. In: Ferri's Clinical Advisor Kliegman RM, et al. Neoplasms of bone. In: Nelson Textbook of Pediatrics. Azar FM, et al. Malignant tumors of bone. In: Campbell's Operative Orthopaedics. Hornicek FJ.
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