 | Radiograph of the pelvis reveals osteolytic and some irregular bone formation in upper femur. Osteopenia in the ilum is most likely due to disuse atrophy.
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 | The lateral radiograph of the upper femur demonstrates these changes more clearly, with considerable irregular new tumor bone in the posterior cortical area of the upper femur. The impression at this time from the clinical story and routine radiographs should be conventional osteosarcoma. |
 | An open biopsy was performed, revealing irregular tumor bone with some degree of pleomorphism, indicating conventional osteogenic sarcoma. |
 | The chest x-ray was clear. Bone scan revealed increased uptake only in the involved upper femur. The diagnosis was Osteogenic Sarcoma IIB and she was started on appropriate chemotherapy. After two months, wide resection of the femoral lesion and prosthetic reconstruction was performed. During this period of chemotherapy, her pain diminished and radiologically the lesion began to fill with healing bone, which suggested effectiveness of the chemotherapy. |
 | This photo of the widely resected specimen demonstrates that the lesion is surrounded by normal tissue. |
 | Photo of the split specimen, demonstrating the intramedullary and extramedullary neoplasm; in addition the presence of tumor is seen within the femoral head, and an undisplaced femur neck fracture is also noted. |
 | The laboratory x-ray demonstrates some increased density within the medullary canal, most likely the result of some healing from the chemotherapy. |
 | Note the pathological fracture of the femoral neck, not yet healed at two months. This is best seen on this lab radiograph of a one centimeter slice of the specimen. |
 | The large histosection of the resected specimen demonstrates indistinct margins of the osteosarcoma, with normal bone above and below the tumor indicating a wide margin. Some attempt at healing is seen of the femoral neck fracture. Little peripheral tumor is seen. |
 | This high power section of the resected specimen demonstrates active remodeling of the turmor bone with osteoclasts and osteoblasts, which also suggests less than 100% chemotherapy induced necrosis. |
 | This high power photomicrograph demonstrates that most of the osteosarcoma is necrotic. It was judged this tumor had overall 90% necrosis from the chemotherapy. |
 | These radiographs demonstrate the pre and post operative views of resection and prosthetic reconstruction. |
 | A recurrence was detected at two years post op, and was resected as noted in this photo. Amputation was considered by the patient, but declined. New chemotherapy agents were given. In addition, heavy radiation therapy was given at the site of the recurrence. |
 | A complication of fracture of the distal femur required revision as seen here. In addition, the patient developed kidney failure from chemotherapy and required a renal transplant which was quite successful for many years.
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 | Nevertheless, despite complications, at twenty one years after first being seen she had no evidence of disease and was doing well, but did have moderate disability due to a painful pseudoarthrosis of the distal femur. There was no evidence of post irradiation sarcoma, but this was a concern for the future. |
 | Radiographs at eighteen years after initial treatment. Unfortunately, she developed a mass in the upper thigh posteriorally; note the soft tissue ossification on these radiographs. The mass proves to be a radiation induced sarcoma, which was widely resected but recurred after four months. It was then treated by hip disarticulation amputation. |
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| At the present time (twenty one years after her initial treatment) at age 37 her outlook is bleak. She has pulmonary metastases, most likely from the high grade radiation induced sarcoma given nineteen years ago, and is also on dialysis. |