Rheumatology- Pediatrics & Bone Malignancy

Question 1

Baker (popliteal) cyst

Answer 1

Extrusion of fluid from the knee joint into the semimembranosus/ gastrocnemius bursa. Seen with underlying knee disorders

Question 2

Presentation of Baker cyst.

Answer 2

Asymptomatic bulge in the popliteal fossa
Swelling of the posterior calf
Sometime pain of posterior calf.

Question 3

Presentation of Osgood Schlatter disease

Answer 3

Pain at the insertion of the patellar tenon
Teen or preteen
Recent growth spurt
Xray: avulsion of tibial tubercle

Question 4

Osteoid osteoma

Answer 4

Benign bone tumor that appears on imaging as small round lucency. Nocturnal pain relieved by NSAIDs

Question 5

Giant cell tumor of the bone

Answer 5

Benign but locally destructive neoplasm this is most commonly at the epiphysis of long bones in young adults. Sometimes associated with Paget disease of bone

Question 6

Signs and symptoms of giant cell tumor of the bone

Answer 6

Local manifestations (pain swelling stiffness)
Xray- soap bubbles (eccentric lytic lesion)

Question 7

Confirm diagnosis of giant cell tumor of the bone

Answer 7

Confirmed with biopsy. Shows multinucleate giant cells resembling osteoclasts intersperse with sheets of mononuclear stroll cells.

Question 8

Tx Giant cell tumor of the bone

Answer 8

Surgery- first line tx

Monoclonal antibodies against RANKL (denosumab) can shrink tumors