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Review Question - QID 3599

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QID 3599 (Type "3599" in App Search)
A 25-year-old male presents complaining of a groin mass which he noticed after a football injury that occurred 1 year ago. He states he was struck in the groin with an opposing player's helmet during a tackle and had a large amount of bruising and pain. While his pain and bruising subsided, he states he noticed this groin mass soon there after and that it hasn't grown and is non-tender. He is otherwise healthy. Inlet pelvis radiograph and T2 MRI with gadolinium scan are shown in Figures A and B. What is the most likely diagnosis?
  • A
  • B

Ossifying lipoma

3%

109/3467

Synovial sarcoma

1%

35/3467

Myositis ossificans

94%

3258/3467

Periosteal chondrosarcoma

1%

45/3467

Inguinal hernia

0%

7/3467

  • A
  • B

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The history, radiograph, and MRI scan are consistent with a diagnosis of myositis ossificans. This benign condition is common after trauma, burns, or surgery secondary to a circulating factor which activates mesenchymal stem cells residing within muscle to form extra-osseous bone. Treatment is conservative in nature and if required, it is recommended treatment be delayed until complete ossification.

The radiograph shows a large area of bone formation in the patient's right groin which on advanced imaging is seen to be well ossified and adjacent to but not stuck on the bone with peripheral enhancement. There are no malignant features suggestive of a process like osteosarcoma on either of these two imaging studies.

Incorrect Answers:
Answers 1 and 2: while many lipomas and synovial sarcomas can have ossification, this pattern of dense ossification is classic for myositis ossificans
Answer 4: Periosteal chondrosarcoma - the location of the lesion isn't on the bone but adjacent to the bone. In addition, a periosteal chondrosarcoma would have mineralization which looked like cartilage, not bone as in this case.
Answer 5: Inguinal hernia - there is nothing in the stem nor images which suggest an inguinal hernia.

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