Malignancies

Malignant bone and soft tissue tumors are uncommon causes of limping in children. However, early diagnosis is critical and can be lifesaving. Leukemia is the most frequent childhood malignancy. The skeleton is often the first body system to display overt manifestations of the acute form of the disease. Osteogenic sarcoma, Ewing sarcoma, leukemia, spinal cord tumors, soft tissue sarcomas, and metastatic tumors of the extremities may cause limb pain or limping.

Causes

Symptoms

• Knee pain is a common complaint in adolescents, but the two most common sites for bone tumors are the distal femur and proximal tibia. Knee pain that Occurs at rest or at night should be a cause for concern.
• Musculoskeletal pain +++ in cases of acute leukemia; described as intermittent, localized, sharp, severe, and sudden in onset
• Lethargy, fever

Signs

• Focal tenderness at the site of a bony tumor may be elicited by direct palpation.
• Thorough general physical examination may show hepatosplenomegaly, lymphadenopathy, pallor, purpura, or bleeding, which can be signs of leukemia or of other malignancies. Palpation of the muscles in the lower extremity may reveal a soft tissue mass as evidence of a rhabdomyosarcoma or other soft tissue tumor. Hyperreflexia or weakness of the lower extremities can point to a tumor in the spinal area.

Treatment

Treatment can occasionally consist of "watchful waiting". The more aggressive forms of disease require treatment with chemotherapy, radiotherapy, immunotherapy and in few cases a bone marrow transplant.