Chronic Inflammation and Its Link to Bone Tumors: the Risks

Chronic inflammation leads to bone tumors?

Hello, Doctor.
At the end of August 2016, I slipped on a slope due to rain and wet roads, with my left foot above and my right foot below.
I did not fall to the ground, but since then, I have felt pain on the outer side of my right knee.
Therefore, in early September 2016, I visited the rehabilitation and orthopedic departments.
After a physical examination, the doctor diagnosed me with a right lateral collateral ligament strain.
After rehabilitation, I only occasionally felt soreness while walking, and my gait appeared normal to others.

In mid-October 2016, I participated in a relay run carrying a 30 kg weight over 5 meters, completing 12 laps.
However, after running, I experienced significant pain in my right knee and had a noticeable limp while walking.
After two days of rest, I returned to experiencing occasional soreness while walking.
On November 2, I underwent a pre-employment physical examination at the hospital, and the physician found no abnormalities during the physical examination.
My white blood cell count (WBC) was 8.2 (reference range 4.0–11 x 10^3/µL).
Until the end of December 2016, I continued to experience occasional soreness while walking, and I underwent ongoing rehabilitation and acupuncture.

In early January 2017, due to work requirements involving heavy lifting and repetitive sitting and standing, the pain in my right knee became unbearable.
The severity of the pain increased with the workload, leading to a noticeable limp that required the use of a cane for walking.
I visited the rehabilitation department of a regional hospital, where I had two musculoskeletal ultrasounds.
The doctor indicated that there was inflammation in the right knee tendon but found no other symptoms, suggesting that I needed sufficient rest for recovery.
On January 19, 2017, I was issued a medical certificate for 30 days of rest.

However, on the evening of January 20, 2017, after receiving cupping and bloodletting treatment for my right knee at a traditional Chinese medicine clinic, I accidentally fell and injured my right leg again.
Due to severe pain and noticeable swelling at the site of the bloodletting and cupping, I went to the orthopedic department of a regional hospital on the morning of January 21, where the doctor arranged for an X-ray.
This was the first X-ray since the end of August 2016.
The doctor reviewed the X-ray and indicated that there was a bone tumor at the upper margin of my right knee, advising me to arrange for an MRI, CT scan, and PET scan as soon as possible.

I would like to ask Dr.
Shi: 1.
Since the doctor pointed out the location of the bone tumor on the X-ray, which coincides with the area where I had bloodletting and cupping, could this treatment affect the accuracy of the X-ray interpretation regarding the diagnosis of a bone tumor? 2.
If it is indeed a bone tumor, considering there is no relevant family history and the progression of the condition suggests it may be due to chronic inflammation, is this type of bone tumor more likely to be benign? What kind of bone tumor could it be? 3.
Given the progression of my condition, have I delayed seeking treatment for too long? 4.
Would an MRI improve the diagnostic accuracy? Which physician in the Hsinchu area could assist with the diagnosis? Thank you again, Dr.
Shi.
Wishing you peace and joy.

Mr. Wu, 20~29 year old female. Ask Date: 2017/01/23

Dr. Shi Guozheng reply Orthopedics

1.
It will not have an impact.
2.
Chronic inflammation does not cause bone tumors; a correct diagnosis must rely on the physician's analysis through imaging.
3.
The onset of the condition is not too long ago.
4.
The diagnosis of bone tumors can be made through the three types of examinations you mentioned, and specialists in bone tumor treatment are usually found in medical centers, such as National Taiwan University Hospital, etc.

Reply Date: 2017/01/23

More Info

Chronic inflammation is a complex biological response that can significantly impact various tissues in the body, including bone. In your case, the history of knee pain and the subsequent discovery of a potential bone tumor raises several important considerations regarding the relationship between chronic inflammation and bone tumors.

1. Impact of Bloodletting and Cupping on X-ray Interpretation: The procedure of bloodletting and cupping may cause localized inflammation and swelling, which could potentially affect the X-ray interpretation. However, it is unlikely that these procedures would create a bone tumor or alter the bone structure to the extent that it would mimic a tumor on an X-ray. The presence of a bone tumor would typically be identified by specific characteristics on imaging studies, such as the appearance of the bone cortex, the presence of lytic or sclerotic lesions, and the pattern of bone destruction. Therefore, while the timing of your procedures and the X-ray findings coincides, it is essential to follow up with further imaging studies like MRI or CT scans to clarify the nature of the lesion.

2. Chronic Inflammation and Bone Tumors: Chronic inflammation can indeed contribute to the development of certain types of bone tumors, particularly benign ones like osteochondromas or even conditions like osteitis fibrosa cystica associated with hyperparathyroidism. However, it is crucial to note that not all bone tumors arise from chronic inflammation. The nature of the tumor (benign vs. malignant) often depends on various factors, including the specific characteristics of the tumor itself, the patient's age, and any underlying conditions. Given that you do not have a family history of bone tumors, this may suggest a lower risk for hereditary malignancies, but it does not eliminate the possibility of a malignant tumor entirely.

3. Delay in Diagnosis: The timeline of your symptoms suggests a progression from a soft tissue injury to a potential bone lesion. While it is understandable to be concerned about whether this delay has worsened your condition, many bone tumors can remain asymptomatic for extended periods. Early detection is always beneficial, but the presence of pain and the subsequent imaging studies indicate that you are now on the right path to diagnosis and treatment. It is essential to act promptly on the recommendations for further imaging and consultations.

4. Role of MRI in Diagnosis: MRI is a powerful imaging tool that provides detailed information about soft tissue and bone marrow involvement, which can be crucial in differentiating between benign and malignant lesions. It can help visualize the extent of the tumor, its relationship with surrounding structures, and any associated soft tissue changes. Therefore, undergoing an MRI can significantly enhance the diagnostic accuracy and guide treatment decisions.

In terms of finding a specialist in the Hsinchu area, I recommend seeking out an orthopedic oncologist or a musculoskeletal radiologist who has experience in diagnosing and treating bone tumors. They can provide a comprehensive evaluation and recommend the appropriate next steps based on your imaging results.

In conclusion, while chronic inflammation can be a contributing factor to bone tumors, it is essential to undergo further imaging studies to clarify the nature of the lesion. Prompt action and consultation with specialists will be key in addressing your concerns and ensuring appropriate management. Please ensure you follow through with the recommended imaging and consultations to get a definitive diagnosis and treatment plan.

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