Assess a child with persistent bone pain for malignancy red flags — long case

A fourteen-year-old boy presents to the general paediatric clinic with three months of worsening pain around the right knee. The pain now wakes him from sleep at night and is not relieved by rest, and his mother has noticed a firm lump on the outer right thigh that seems to be growing. He has attributed the pain to football. A plain radiograph of the knee shows a mixed lytic and sclerotic destructive lesion in the distal femoral metaphysis with a sunburst periosteal reaction and a Codman triangle.