Images of Musculoskeletal Oncology

Osteosarcoma
A teenage boy had pain, swelling and shoulder stiffness for several months.

This AP of the shoulder revealed a typical conventional osteosarcoma, with many irregular modules of dense masses of the osteosarcoma within bone and the peripheral tissue. In addition, note the areas of bone destruction in the humeral head and neck regions. The histosections revealed a typical high grade osteosarcoma. Although the Dx of osteosarcoma could be made from the routine radiographs alone, histological confirmation of the diagnosis of high grade osteosarcoma is usually performed. A successful resection and prosthetic allograft reconstruction was performed, and proper chemotherapy administered.

High power photomicrograph reveals the typical pattern of high grade osteosarcoma that has infiltrated normal bone, and is seen here engulfing a trabeculum of normal bone.
This photo of the resected specimen demonstrates a wide margin of normal tissue. However, because of brachial plexus involvement, a forequation amputation was done and the patient eventually died of widespread metastases.
Learning Issues:

In some conventional osteosarcomas the diagnosis can be made from the history, physical findings, and routine radiographs alone. Brachial plexus involvement sometimes makes limb sparing surgery difficult.


Images of Musculoskeletal Oncology
University at Buffalo Department of Orthopaedics