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Pain near bone lesions in right femur
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Pain near bone lesions in right femur

I fell down the stairs back in 9/2011. Because I was on Lupron for endometriosis and knew there was an increased risk of fracture (despite taking Add-Back), I decided to get myself to a convenient care for an x-ray. When I got there, they did x-rays of my right knee and right ankle. They found no signs of injury...but they did find bone lesions.

From the x-ray report: "There are at least 2 intramedullary radiolucent lesion of the distal femoral diaphysis, measuring 1.4 x 0.9 cm and 2.8 x 1.0 cm. These lesions show mild peripheral sclerotic changes without appreciable cortical erosion or soft tissue components."

I was told to follow-up with my PCP, so I did. She had me get an MRI and meet with an orthopedic surgeon...who told me he couldn't tell me what they were (and that if they needed surgical removal, they're in a really bad spot for it), and he sent me to an orthopedic oncologist...who barely scrolled through the images from my MRI (he had his fellow do the interview while he was out of the room; he totally didn't care about anything except getting my appointment over with) and gave me a diagnosis of nonossifying fibroma and seemed to kick me out of his office.

Based on how little concern the orthopedic oncologist seemed to have for me (he was probably in the same room with me for...oh, a full minute, if that), I decided to get a second opinion. I tried to find someone with the expertise closer to home and found someone who felt she could look at my films and help me. I met with her, she reviewed the first MRI...and told me to get a second MRI in a few months for monitoring, see if they changed. Okay. Makes sense.

From MRI #1: The T1-weighted sequences demonstrate at least 3 well-defined intramedullary lesions of the distal femoral metadiaphysis, mostly located posteromedially adjacent to the endosteum. These lesions are of intermediate to low signal intensity in the T1-weighted sequences at homogeneously hyperintense and inversion recovery at T2-weighted sequences. The largest lesion measures approximately 7 x 5 x 4 mm. Based on the recent plain radiographs, there may be apparent in sclerotic halo surrounding the largest lesion, indicating a benign etiology. Based on the current MRI images, no evidence of endosteal scalloping, cortical erosion or soft tissue components are demonstrated. After infusion of the IV contrast, no suspicious enhancements are seen. The differential considerations therefore include eosinophilic granuloma, aneurysmal bone cysts and or osteoid osteomas. Other less likely lesions include fibrous dysplasia and giant cell tumor.

From MRI #2: The 3 lesions of in the distal femoral shaft are again demonstrated with the largest measuring about 7.8 mm. Similar findings were present on the previous study dated 10/13/2011. There is a sclerotic rim around the high signal T2-weighted lesion. The postcontrast images demonstrate no significant enhancement. This may be cystic although the differential diagnosis was described previously and included eosinophilic granuloma, osteoid osteoma and aneurysmal bone cyst.

When I went back to the second opinion doctor, she said they appeared to be stable (though I'm not sure I can understand that, given the disparity in sizes these reports state) and that it wasn't necessarily important to put a term on the type of lesion because as long as they were benign, the kind didn't matter.

Umm...yeah.

She ended up leaving the practice, and I have started to have pain in the area of the lesions. I had pain there before off and on, but it wasn't as frequent as it's been the past week or so, and the pain level wasn't as high as it is now (granted, it's still not HIGH, but it's definitely higher).

So I'm left wondering...what is really going on? The imaging tests suggest eisinophilic granuloma, aneurysmal bone cyst, osteoid osteoma, or less likely fibrous dysplasia or giant cell tumor. But then the orthopedic oncologist, in his 10-second flip through the several images, tells me nonossifying fibroma, which my research says occurs as a solitary lesion and is "very rare" to occur as multiple lesions. And the second opinion wanted the second imaging test to see if it's growing, and from what I read, the largest was 7x5x4 for the first MRI and the second MRI has an image showing the dimensions at 7.77 x 5.96...which seems like it's growing to me.

I accept that they're benign, so I'm not worried about cancer. I'm worried about them growing and causing a fracture. If I knew what kind of lesions they were, I could possibly figure out what to do in regard to treatment or pain management.

Anyone have any ideas how to deal with this? I have an appointment set up for next Saturday for a physical, so I plan to bring this up with my PCP then and monitor the pain and the occasional weakness I feel in the leg between now and then. I just want an official answer!
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