Case history
Case history
A 14-year-old boy presents with complaints of right knee pain of approximately 2 months' duration. He remembers falling during football training 2 months ago, but the trauma was not severe enough to seek medical attention. Shortly afterwards, he started having pain at night or after football practice. The pain would initially subside with rest and non-prescription analgesics. However, for the past 2 weeks the pain has increased in intensity, causing him to limp. His mother has noticed his right thigh is slightly larger than the left. It is also warm and tender to touch.
Other presentations
The typical presenting symptom in patients with osteosarcoma is initial mild pain that becomes increasingly severe, usually of several months' duration. The pain is commonly described as deep, dull, and unremitting; in about a quarter of patients it is more severe at night.[2] Because patients are usually young, the pain is often wrongly attributed to exercise, a growth spurt, or trauma. The pain also often temporarily responds to non-prescription medication and lifestyle changes, which can further delay diagnosis. Swelling or a mass follows shortly after the onset of pain. It is sometimes accompanied by a reduction in range of motion. Large tumours associated with little pain are unusual but may still occur. A pathological fracture can be the presenting event, predominantly in patients with osteolytic tumours. Low-grade surface osteosarcoma may present with a painless mass and/or limited range of motion if the tumour is located close to a joint.
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