Category: Clinical Sciences/Health Conditions
Case Diagnosis: Pediatric Patient with Osteosarcoma in the Iliopsoas following Screw Fixation for SCFE
19 year-old male who had a left femoral screw fixation for SCFE at age 8 presented with 3 months of worsening left hip pain. Physical exam revealed stable vital signs, left hip edema, tenderness, limited range of motion, and left lower extremity weakness. Labs revealed WBC 30,000/mm3, ESR >130mm/hr, CRP 202.4mg/L, lactate 4.1mmol/L. Empiric antibiotics were started for likely soft-tissue abscess. Left hip X-Ray revealed SCFE pin in place. CT revealed a Left iliopsoas lesion concerning for primary soft-tissue malignancy. MRI abdomen and pelvis showed a massive lesion extending from the level of L4 vertebral body to the left femoral lesser trochanter. Biopsy revealed high-grade pleomorphic osteosarcoma, and the patient was started on chemotherapy. He was diagnosed peripheral nerve entrapment causing intractable left hip pain by Pain management and was started on a neuropathic pain regimen with some relief.
There is a rare but known association between implanted orthopedic hardware and local soft-tissue and bone cancer, including in the pediatric population, which clinicians should be aware of to avoid misdiagnosis. Further studies are necessary to determine the link between the two and the risks imposed.