Images of Musculoskeletal Oncology

Osteosarcoma
A teenage boy was seen with a two month history of thigh and knee pain, and a mild limp. On physical exam the distal femur was enlarged and slightly tender. Knee motion was slightly restricted.

The AP and lateral radiographs demonstrate a dense bone lesion filling the distal diaphysis and metaphysis, which has spread into the adjacent soft tissue, but demonstrates a smooth border. The impression at this point should be osteogenic sarcoma, conventional type.
The CT scan reveals that the lesion has filled most of the medullary canal, and rules out parosteal osteogenic sarcoma.
Total body bone scan reveals marked uptake of the isotope only in the lesion.
Histosection demonstrates high grade osteosarcoma. The diagnosis was osteosarcoma IIB. The treatment given in 1980 was chemotherapy and high thigh amputation. At the time (1980) amputation was not an uncommon method for achieving wide resection of the neoplasm.
Demonstrates the tumor filling the medullary canal, with fairly smooth peripheral borders. The diagnosis may have been a parosteal osteogenic sarcoma that may have dedifferentiated to a high grade osteogenic sarcoma and spread into the medullary canal.
A post amputation photo of the patient in his uniform as a lacrosse player. He is a successful high thigh amputee, and remains free of disease 27 years after his treatment.
Learning Issues:

1. Conventional osteocarcoma has a variety of radiographic presentations, including a high dense lesion with a smooth border.

2. High thigh amputation is often well accepted by adolescents and young adults; it is not the end of their active world



Images of Musculoskeletal Oncology
University at Buffalo Department of Orthopaedics