Copyright 2009
Author John Udall MD
Definition
Tumors around the knee common place for ocurence in the pediatric population, but they can occur in any age group. There are a number of tumors that can affect the bony and soft tissue structures about the knee. Some of these tumors include osteosarcoma (most common malignant tumor in the adolescent population), chondroblastoma, osteochondroma, synovial chondromatosis, giant cell tumor, chondrosarcoma, non-ossifying fibroma, malignant fibrous histiocytoma, lymphoma, and Ewing’s sarcoma to name a few.
The most common initial complaint for patients presenting with tumors around the knee is pain. They are characterized by a change in the size of the knee in many cases, pain, pain at night, weight loss, fatigue, and swelling.
Tumors are usually caused by a mutation in a cell line in, often times in a genetically susceptible individual.
Tumors can be complicated by fractures of the tibia or femur. It is not uncommon for a young active patient will come in with a tumor about the knee which is misdiagnosed as a sports injury because of the active lifestyle of many of these patients which would leave a practitioner to believe pain was secondary to a sporting injury.
Diagnosis is suspected clinically by history, physical exam, and imaging studies.
Imaging includes the use of plain x-rays which should always be obtained in a patient where tumor is suspected. MRI is almost always obtained as well, since it gives a very acurate picture of bony and soft tissue involvement. Bone scans can also be obtained which can help discern the extent of metastisis to other body parts. Often times imaging studies of the chest abdoman and pelvis will be obtained since these are common areas of metastisis for many of these tumors.
Treatment options depend on the type of tumor but ranges from observation, to chemotherapy, surgery, and even amputation occasionally. Limb salvage has been more of an emphasis in recent times with tumors such as osteosarcoma since chemotherapy with tumor resection has the same mortality rate as ampuation.
References
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