Parachordoma is a rare tumor, with fewer than 100 cases reported. We present an unusual presentation of a long tumor tracking along the median nerve, with regional metastasis to the axillary nodes in a 67-year-old woman. The tumor extended from the wrist proximally along the forearm to the elbow, coursing intraneurally along the median nerve. We present this case due its rarity, interesting radiographic appearance, and atypical presentation.

Intra-articular tumors of the knee are most commonly benign. Overall, this is a relatively rare clinical presentation. The differential diagnosis includes pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, synovial hemangioma, and very rarely primary sarcoma (synovial sarcoma being the most common). The clinical presentation for these conditions is usually non-specific, but radiographic and advanced imaging findings are able to differentiate some of these tumors. It is essential to obtain and send tissue specimens to pathology for histologic analysis to rule out a primary malignancy as a missed diagnosis can have grave implications on patient outcomes. This review summarized key aspects of diagnosis and treatment for these conditions.

Patients commonly present to orthopaedic surgeons with suspicious and low-energy mechanisms of injury for long-bone fractures. Most tumor-related pathologic fractures in patients older than 40 years are due to metastatic disease. Although rare, the treating surgeon should always consider the possibility of a primary bone tumor. Obtaining a tissue sample is a required early step in the surgical process following the principles of biopsy tract selection. An adequate tissue biopsy is also necessary for the diagnosis of a primary source of metastatic disease if otherwise unknown. These patients often require adjuncts to surgery, including bisphosphonate treatment, anticoagulation, radiation therapy, chemotherapy, and follow-up with multiple medical specialists for continuing care. The surgical treatment plan is based on the location of the fracture, and various options are available depending on whether the metastatic disease is present in the diaphysis, metaphysis, or epiphysis of long bones. The orthopaedic surgeon should have a working knowledge of proper identification and treatment principles of metastatic disease in long bones to properly assist in patient care delivery.