osteochondroma vs. osteosarcoma

[sharon4402]

My five year old was diagnosed with an osteochondroma on his right knee about a year and a half ago.  He had been limping and complaining of pain for a few days so I called our family doctor and he met us at the ER at 7am the next morning.  The lump was visible to us for a few months before this, but didn't seem to cause him pain, so I didn't have it looked at.  He had x-rays done and then referred us to an orthopaedic surgeon.  After looking at the xrays, the surgeon said he was confident that it was just an osteochondroma and that he would observe it's growth yearly and remove it before it became problematic.  That being the news I wanted to hear, I never second guessed him, but am now feeling I should have.  Over the past few months, he has complained of pain off and on and last week I received a call from his teacher telling me that he was having a hard time writing.  When I questioned him on this he said it was hard to write because his arm hurt.  I asked him to describe the pain and he said it was like the pain in his leg.  They cancelled our last follow up appointment as the doctor had to go out of town and then we moved and I forgot to call and reschedule.  So, that one appt. is the only one he has had (June 2006).  I called to make another appointment and have been given one several months from now despite his pain (here's hoping they don't cancel that one).  I have been unsuccessful finding another doctor that will see a child as young as him.  Also, these doctors specialize in sports medicine, so I am not sure if he is even seeing the right people.  Should more tests have been done?  I have read that an osteochondroma is very rare in a child under 10, but they were very quick to diagnose it as one.  I have many concerns and my hands are tied until June.  Does anyone have any experience with osteochondromas and more importantly a misdiagnosis of osteochondroma.  I really don't want much more time to pass.  I need to be pointed in the right direction.

[Fernando Roque, MD]

Hi.  Was the diagnosis of osteochondroma done without the benefit of a biopsy?  If not, I think you should seek a second opinion with an orthopedic oncologist and have that mass biopsied at the soonest possible time.  At this point, the possibility of osteosarcoma cannot be discounted and I think there is an urgent need to investigate this further.

[sharon4402]

Thank you so much.  No, there was no biopsy, no blood work...just an x-ray.  The tumor is very apparent both externally and on the x-ray.  We are seeing his PCP in the morning as he has been sick off and on for the past few weeks (flu, I think), but we may have something secondary as he has now had a fever for five days.  Poor little guy!!  I am going to discuss my concerns with this other situation and hopefully get to a doctor who does not have such a full schedule and actually specializes in this.  I will post with results of this visit.  Again, thank you so much for your response!

[sharon4402]

Thank you so much.  No, there was no biopsy, no blood work...just an x-ray.  The tumor is very apparent both externally and on the x-ray.  We are seeing his PCP in the morning as he has been sick off and on for the past few weeks (flu, I think), but we may have something secondary as he has now had a fever for five days.  Poor little guy!!  I am going to discuss my concerns with this other situation and hopefully get to a doctor who does not have such a full schedule and actually specializes in this.  I will post with results of this visit.  Again, thank you so much for your response!

[sharon4402]

Had my son at pediatric orthopaedic today (was unable to keep last appointment as we had strep throat through the family).  Dr. was baffled at first doctor's quick diagnosis of osteochondroma given my son's age, the location of the tumor and the pain associated (it is tender to the touch).  They took several x-rays and we are to have an MRI as soon as we get insurance approval.  He did assure me that whatever comes out of it, even if it is a malignancy, the prognosis is excellent.  I will post again! I appreciate you all being here!  

[Fernando Roque, MD]

Hi.  Feel free to post an update. We're very interested about developments regarding your son's condition.  We'll try to help in any way we can.