For the past eight months, a woman aged 78 years has experienced anterior thigh pain that intensifies when she coughs. She has a history of uterine and breast cancers. X-ray reveals arthritis of the hip and an old bone infarct of the thigh at pain site. Could this be osteosarcoma? — Lillian Riddick, ANPC, PhD, Bridgeport, Conn.

Breast cancer and uterine cancer do not typically cluster with sarcoma. If the woman received radiation therapy, the risk for such secondary malignancy as sarcoma would be confined to the radiation field. If you are concerned about sarcoma, an MRI is the best choice. Re-evaluation with an oncologist will determine if there is any recurrence. — Deborah L. Cross, MPH, CRNP, ANP-BC (163-1)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.