A 15-Year-Old Boy Comes to the Physician with Left Shoulder

A 15-year-old boy comes to the physician with left shoulder joint pain and swelling.  He has had these symptoms for the past 3 months and they are getting progressively worse.  He has no fever, weight loss, or night sweats.  The patient lifts weights and plays baseball 5 days a week.  He has taken acetaminophen and ibuprofen with little relief.  Examination shows a tender mass at the left proximal humerus.  Range of motion is normal.  Laboratory evaluation shows elevated alkaline phosphatase, erythrocyte sedimentation rate, and lactate dehydrogenase.  X-ray of the shoulder is shown in the photograph below. Which of the following is the most likely diagnosis?

A) Ewing sarcoma
B) Osteoid osteoma
C) Osteomyelitis
D) Osteosarcoma
E) Stress fracture

Correct Answer:

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