A 28-year-old male amateur player was referred to a FIFA Medical Centre of Excellence with a history of occasional left sided radicular leg pain. At the time of his referral he had a working diagnosis of ‘piriformis syndrome’. The main clinical examination finding was pain with rotation of the left hip.
An x-ray shows an expansive lesion within the left inferior pubic ramus. An MRI of the pelvis and proximal thigh (with contrast) further demonstrates a lesion involving the left inferior pubic ramus. The axial T1 image shows a hypointense, oval and elongated lesion involving the left inferior pubic ramus. There is also a dishomogeneous appearance of the near fat tissue. An axial T1 image with contrast show enhancement of both the entire lesion and the adjacent fatty tissue.
After obtaining the MRI findings, the patient underwent surgery to excise the lesion. The histological examination revealed a chondroblastoma, a rare intermediate grade cartilaginous neoplasm (which is not common at this site). X-ray and MRI follow-up was performed four months after treatment and showed good bone healing and no evidence of recurrence, complications involving the surrounding soft tissue or deficit of the sciatic nerve. Nine months after surgery, the patient has returned to his regular sporting activity. A follow-up examination, after two years, showed complete recovery.
Chondroblastomas are generally found in the epiphysis and apophysis of the long bones, especially in males. This type of lesion is rarely seen in the pelvis. Patients typically present with non-specific symptoms including joint pain, muscle atrophy, tenderness, swelling and rarely a palpable mass. In our case the patient presented with radicular pain followed by non-specific abdominal pain. Chondroblastoma (and other tumours) are uncommon in athletes however they must be considered as a possible cause of symptoms. This is especially true when a player presents with an insidious onset of pain in the absence of trauma.
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