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JAMA Surgery Clinical Challenge
July 2013

Cystic Lesions With Suspected Soft Tissue Infiltration

Author Affiliations
  • 1Department of Surgery, University Hospital, Ulm, Germany
  • 2Department of Trauma Surgery, University Hospital, Ulm, Germany
  • 3Department of Nuclear Medicine, University Hospital, Ulm, Germany
  • 4Department of Pathology, University Hospital, Ulm, Germany
  • 5Department of Internal Medicine and Endocrinology, University Hospital, Ulm, Germany
JAMA Surg. 2013;148(7):691-692. doi:10.1001/jamasurg.2013.307

In April 2010, a 19-year-old soccer player presented with a 4-week history of pain after a tap against his right knee. Medical and family histories were unremarkable and no abnormalities were found on physical examination. A radiograph of the right knee showed osteolytic lesions in the distal femur and the head of the tibia.

On magnetic resonance imaging, the epiphyseal lesions were visualized as cystic and nonsclerotic and extended to the articular surface of the distal femur and proximal tibia (Figure 1). Soft tissue extension was suspected from the tibia. Laboratory test results showed normal blood cell count, renal function, and concentration of C-reactive protein.

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