Missing the Malignancy in Primary Care: A Case Study on Pediatric Osteosarcoma

Osteosarcoma is the most common malignant bone tumor in pediatric and adolescent patients. Typical symptoms include nonspecific localized bone pain often occurring during the adolescent growth spurt. The timing and presentation of symptoms frequently lead primary care providers to associate them with benign conditions such as growing pains or sports-related injuries. As a result, diagnosis is frequently delayed. This case study examines a 14-year-old female whose persistent leg pain was initially misdiagnosed in a primary care setting, resulting in a delayed diagnosis of osteosarcoma. Despite normal initial imaging and examination, the patient later presented with worsening symptoms and neurological deficits, prompting advanced imaging and biopsy that confirmed malignancy. This case highlights the diagnostic challenges in primary care and the need for increased clinical awareness, standardized guidelines, and structured follow-up in pediatric patients presenting with unexplained, unilateral bone pain.