Metastases to soft tissue from any source are rare, with carcinomas being the most common primary lesion8,9. Metastases from osteosarcomas most commonly are observed in the lungs or bone and rarely are observed elsewhere in the absence of widely disseminated disease10. We present the case of a patient with a distal femoral osteosarcoma who, at the time of diagnosis, had an isolated metastasis to the soft tissue of the chest wall. The purpose of this report is to emphasize the need to consider metastatic disease as a possible explanation for any soft-tissue mass that is discovered at the time of diagnosis, or during treatment, of osteosarcoma.
A thirty-six-year-old man came to us with a two-month history of pain and swelling in the right knee. The patient had been taking ibuprofen to relieve the pain, which initially had been a mild, constant ache involving both the knee and the distal part of the anterior aspect of the thigh. The pain was exacerbated by activity. The patient also noticed mild swelling in the anterior aspect of the thigh. The pain worsened acutely two weeks prior to presentation, when the patient landed on the right leg while playing basketball. Since that time, the pain had begun to awaken him at night and had not been relieved by over-the-counter medications.
During the same two-month period, the patient had a firm, painless lump in the left axillary region; the lump had increased slightly in size. He also reported that swelling had been present in the popliteal region of the contralateral knee for approximately two years. He reported no fevers, chills, or night sweats and had noted no decrease in energy level or appetite.
Upon referral to his local orthopaedic surgeon, the patient was evaluated with radiographs of the right …
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