A 10-Year-Old Boy Is Brought to the Office Due to Left

A 10-year-old boy is brought to the office due to left knee pain and difficulty walking.  His parents say that he developed knee pain several months ago, but it was mild and did not affect his mobility.  Over the past week, the patient has had increasing pain that prevents him from playing soccer or basketball.  He describes the pain as continuous, nonradiating, and sometimes worse at night.  The patient has taken ibuprofen but it has not relieved the pain.  He does not recall any preceding trauma.  He has had occasional fever over the last month; temperature today is 37.2 C (99 F) .  The patient has an antalgic gait and favors the right side.  The left knee is swollen and erythematous.  A tender, immobile mass is palpated above the left knee.  Laboratory results are as follows: X-ray of the knee shows a central lytic lesion in the distal femur with cortical layering, a "moth-eaten" appearance, and extension into the soft tissue.  Which of the following is the most likely diagnosis in this patient?

A) Ewing sarcoma
B) Fibrosarcoma
C) Giant cell tumor of bone
D) Juvenile idiopathic arthritis
E) Multiple myeloma
F) Osteoid osteoma
G) Unicameral bone cyst

Correct Answer:

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