 | Routine radiographs of the destructive and bone forming lesion in her distal femoral metaphysis. The lesion has rather indistinct and subtle borders and appears to be a serious lesion.
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 | The MRI more clearly outlines the bone lesion. The biopsy should be done only after staging studies like this MRI to avoid introducing the artifacts of the biopsy. |
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 | The total body bone scan demonstrates an increased uptake of isotope only in the distal femoral lesion. A chest x-ray was normal |
 | Open biopsy was done, demonstrating the high grade osteosarcoma with pleomorphic nuclei and the tumor new bone. Note the variation in the tissue from small to large amounts of tumor bone. Tumor has spread laterally outside the bony compartment. The diagnosis of osteogenic sarcoma IIB was made. (High grade tumor spread outside the bony compartment). |
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 | The patient was started on appropriate chemotherapy two months later. This radiograph demonstrates increase in the density of the lesion, which strongly suggests some beneficial healing in the lesion itself from the chemotherapy. |
 | The MRI (repeated just before the surgical resection) demonstrates the well defined metaphyseal border and what appears to be penetration of the epiphyseal plate laterally. |
 | This photograph demonstrates the widely resected tumor, including the biopsy site. |
 | The specimen radiograph confirms the wide resection. |
 | This image of the large histosection demonstrates the cortical destruction laterally and the penetration of the lateral portion of the epiphyseal plate. |
 | A high power photomicrograph reveals the effect of the neoplasm on the lateral portion of the epiphyseal plate. The plate is limiting the spread to some extent. |
 | A diagram of the large histosection indicates that necrosis has occurred in over 80% of the tumor. This is suboptimal necrosis, but still an important aspect of the chemotherapy effects. |
 | Histosection of necrotic neoplasm seen in the resected specimen. Note the acellularity. |
 | High power histology demonstrates epiphyseal penetration by tumor. |
 | Reconstruction was by prosthetic distal femur and total knee joint with a good immediate result. |
 | However, the total knee failed, and required revision several years later. |
 | The patient was without evidence of disease ten years after the initial wide resection, but required three operations because of implant failures. She may now require patella resurfacing because of persistent anterior knee pain.
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