Review Question - QID 212441

A 16-year-old boy presents to his pediatrician’s office after noticing right leg pain for the past 2 weeks. The patient first noticed the pain 2 weeks prior after a soccer game. He did not report any significant injuries at the time. He states that the pain is intermittent, but he tends to notice it while he is in bed at night. Recently, the pain has been getting worse and is a gnawing pain mainly localized to his right lower thigh. On exam, his temperature is 98.2°F (36.8°C), blood pressure is 114/76 mmHg, pulse is 68/min, and respirations are 12/min. There is no gross deformity of his extremities, but he does cite some tenderness to palpation on his anterior thigh immediately superior to his right knee. Motor and sensory function are intact. After imaging is obtained, a bone biopsy is performed and is found to contain pleomorphic cells with osteoid production (Figure A). Which of the following is also associated with this type of lesion?