Traumatic Ossifying Periostitis of the Ulna Masquerading as a Malignancy in a Football Player

Abstract

Whenever a patient is seen with a palpable extremity mass, the clinical question is often whether the lesion is benign or malignant. The history, physical examination, laboratory findings, and imaging studies must all be considered to arrive at a probable diagnosis and to formulate an appropriate management plan. In cases of suspected malignancy, the next step is often to take a biopsy. However, traumatic lesions should not undergo removal of biopsy tissue because removal could exacerbate the underlying condition, complications could occur, or worse, an exuberant tissue reaction could be mistaken for a malignant process. We report on a high-school football player with an upper extremity lesion who was referred to our orthopaedic oncology clinic for a suspected malignancy of the forearm. He was found to have bilateral ossifying periostitis of the ulnas due to repetitive trauma. The correct diagnosis was obtained by correlating the imaging studies with the clinical history and physical examination.We reviewed the current literature on ulnar stress fractures and posttraumatic ossifying periosteal lesions masquerading as malignant lesions. CASE REPORTA 17-year-old male high-school student was seen at an outside facility and reported 2 weeks of pain and tenderness over his left ulna. Plain radiographs revealed periosteal new bone formation along the ulnar border of the left ulna with a few cystic lucencies within this new bone (Fig. 1). A CT scan showed a &dquo;sunburst&dquo; pattern of periosteal new bone formation with some erosion of the volar cortex of the ulna (Fig. 2). A magnetic resonance imaging (MRI) scan of the same area revealed both periosteal and marrow abnormalities, which were of low-signal intensity on T1-weighted images and of increased signal intensity on T2-weighted images (Fig. 3). I%+ a , $ Q # z Figure 1. Plain radiograph of the left forearm shows periosteal new bone formation along the diaphysis of the ulna. Also note the small, vague cystic lucencies within this periosteal new bone.

Stress-Induced Spiculated Periosteal Reaction Appearing as a Malignant Bone Tumor: A Case Report

“…Two cases of stress-induced spiculated periosteal reaction have been published. 5,6 In both cases, the lesions were in the ulna and were due to repetitive stresses caused by sports participation. In one case, the spiculated reaction occurred along with evidence of radioulnar IOM stress injury.…”

Simple Subperiosteal Hematoma with a Periosteal Reaction Mimicking a Malignancy

“…한편, 잦은 외상 또는 스트레스 등에 의해서도 골막 반응이 나타날 수 있으며 이는 주로 양성 소견을 보이며 균 질하면서도 연속적인(solid uninterrupted) 양상이다. 2) 현재까지 저 자들의 문헌 고찰 결과, 운동 선수에서 만성적 스트레스(stress)로 야기된 "악성 종양에서 보이는 골막 반응"이 2예, 3,4) 치골 부위의 외상으로 역시 "악성 종양에서의 골막 반응"이 보인 1예, 5) 결핵으 로 인한 "악성 종양의 골막 반응"이 보인 1예 6 상의 골막 반응이 골절 부위와 근처에서 관찰된다. 8,9)…”