Working Diagnosis:
Osteoid Osteoma in lateral lesion
Diffuse Large B Cell Lymphoma in medial lesion

Treatment:
Osteoid Osteoma (lateral lesion)
- Radiofrequency ablation treatment
Diffuse Large B Cell Lymphoma (medial lesion)
- Chemotherapy - Rituximab, Cyclophosphamide, Doxorubicin, Vincristine & Prednisolone 9R-CHOP), 6 cycles
- After chemotherapy, 17 rounds of radiation treatment

Outcome:
Post treatment MRI Right Knee w/o contrast (Sept. 25th, 2016):
Post-treatment changes; New marrow signal alteration & enhancement, concerning for recurrent disease.
Case Photo #7 Case Photo #8 Case Photo #9 Case Photo #10
Bone Biopsy (Oct. 11th 2016):
Negative for malignancy

Return to basketball protocol:
After chemotherapy and radiation treatment was completed, he progressed through closed chain lower body strength exercises, functional strengthening, plyometrics, stationary bike & alter G running. Fourteen months after diagnosis and six months after remission, he returned to unrestricted basketball.

Author's Comments:
Advanced imaging should be considered in patients with persistent or undifferentiated symptoms, despite negative initial imaging.
Both benign and malignant bone tumors cause pain.
The multidisciplinary approach consisting of physicians and athletic training staff of treating athletes with cancer is crucial for expedited diagnostic, therapeutic interventions and return to play.

Editor's Comments:
Osteoid osteoma is most common in the lower extremity of males in their second decade. The proximal femur is the most common location with the tibia being second. Patients most often present with chronic, nighttime pain unrelated to activity.

References:
Tis, J. E., Phillips, W., & Torchia, M. M. (2017, Sep). Benign bone tumors in children and adolescents. UpToDate.

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