1. 14 years old girl pain in the leg

3. specialities Traumatology Orthopedics Rheumatology Immunology Infectology Hematology Oncology General pediatrics

4. questions Which leg? Exactly where? Since when? Did she have it earlier? Any trauma? Also painful in the night? Does she need any medication? Immobility? Pain in other localisation? Earlier disease? Chronic disease? Skin symptoms? Fever, diarrhoea?

5. examination Physical examination Blood –CBC, CRP, We, smear –PCT, CK, LDH –serology: Staph., Strepto., Salmonella, Yersinia, Campylobacter, E.coli, Borellia, tbc –AI: RF, ANA, ANCA, SCAT Radiology –X-ray –US –MR –CT –Bone scintigraphy

6. 14 years old girl leg pain No trauma No fever in the last periode In the anamnesis no severe disease Left knee painful – always on the same localisation After physical activitiy pain increases Sometimes she weaks up during the night because of the pain Sometimes she needs analgetics 2 weeks duration, always on the same place localised bone-painX-ray

7. 14 years old girl leg pain 2 weeks duration, always on the same place localised bone-painX-ray suspected malignancy  open biopsy  dg: osteosarcoma

8. 14 years old girl leg pain dg: osteosarcoma Staging: Staging:local MRI bone scintigraphy chest CT/MRI Therapy: Therapy: neoadjuvant chemo operation adjuvant chemo

9. OSC OSC over-all survival Follow-up (months) 180160140120100806040200 Survival probability 1,0,8,6,4,2 0,0 metastatic non-metastatic