Medical History A 17-year-old female presents to the office complaining of dull right knee pain, which she relates to a lesion provoked by falling from height. History of a similar episode 4 months ago, when was prescribed common analgesia. She had good initial response, although, the symptoms recurred, with a progressive worsening of the pain, despite the analgesia. Physical exam shows right knee effusion and discrepancy between tights’ circumference. Plain radiograph of the tight and right knee pointed a non-specific subperiosteal thickening. Magnetic resonance imaging (MRI) was performed (images 1 to 3). Magnetic resonance image of the right thigh, T1-weighted, coronal viewContrast-enhanced magnetic resonance image of the right thigh, coronal view, T1-weightedMagnetic resonance image of the right thigh, T2-weighted, coronal view Question:Considering the case report and the findings on the MRI, which is the most adequate approach in this moment? Perform excisional biopsy of the lesion to diagnose the bone tumor Communicate the suspicion of malignancy to the family, perform incisional biopsy of the lesion and the following exams: complete blood count, CRP, hepatic and renal function panels and serum electrolytes Communicate the suspicion of malignancy to the family and transfer the patient to a referral hospital, where the diagnostic workup and management of the bone tumor will take place Ask a computed tomography (CT) with the purpose of locally staging the tumor, communicate the suspicion of malignancy to the family and ask them to look for an orthopedic oncologist Time is Up! Time's up
