Case report

Osteogenic Sarcoma

Patient Profile
Patient Information
3606079-4
O 19 y/o male

Chief complaint
soreness over right leg since March 2008
sport injury, received rehabilitation on LMD
Leg broke while he was standing wearing his socks on
2008/6/18

Past History
No special history

Brief History
08/March
08/6/18

6/28 Plain
film

19y/o, male, suffered from soreness over right leg

was sent to hospital where distal femur
fracture was noted. Specimen was checked which
revealed osteosarcoma with pathological fracture.

7/09 MRI

08/7/1208/9/8
08/9/29
08/10/7-

received 4 courses of neoadjuvant chemotherapy

received operation for right femur OGS

received 8 courses adjuvant chemotherapy

Chest CT on 2009/07/22 showed several nodules

with calcified spot at Right lung

09/2/10

7/22 CT

09/7/22

OGS Concern
Soft tissue ossification
Medullary and cortical b
one destruction
Skip lesion
Joint involvement
Lung metastasis

08/06/28 Plain film

Periosteal
reaction

Medulla
ossification

osteolytic lesions with

permeative margin
Periosteal
reaction

Soft tissue ossification

Periosteal reaction

Conclusion-Plain Film
Pathologic fracture at distal femur with di
splacement and soft tissue swelling.
Soft tissue ossification: Sunburst sign
Osteolytic lesions: ill-defined
Periosteal reaction

OGS Concern
Soft tissue ossification
Medullary and cortical b
one destruction
Skip lesion
Joint involvement
Lung metastasis

Brief History
08/March
08/6/18

6/28 Plain
film

19y/o, male, suffered from soreness over right leg

was sent to hospital where distal femur
fracture was noted. Specimen was checked which
revealed osteosarcoma with pathological fracture.

7/09 MRI

08/7/1208/9/8
08/9/29
08/10/7-

received 4 courses of neoadjuvant chemotherapy

received operation for right femur OGS

received 8 courses adjuvant chemotherapy

Chest CT on 2009/07/22 showed several nodules

with calcified spot at Right lung

09/2/10

7/22 CT

09/7/22

08/07/09
MRI
STIR/T1/T2

Low signal mass

involving soft tissue and bone medulla

Internal
hemorrhage
Cortical
breakthrough

Bone edema

Subcutaneous + soft tissue edema

Post-contrast

Axial T1+ C

Neurovascular bundle

Conclusion-MRI

Diaphysis of RT distal femur, 8.3 x10.3 cm in size

Internal hemorrhage
Pathological fracture and displacement
Periosteal reaction
The mass showed post contrast heterogeneous enha
ncement, evident necrosis of central portion, viable t
umor portion was mainly at margin
Surrounding soft tissue edema
The joint was spared.
Neurovascular bundle compressed
No definite skip metastasis (STIR)

Differential diagnosis
Osteosarcom
a

Metaphysis

Soft tissue involvement

Aggressive periosteal
reaction
-Sunburst type
-Codman triangle

Osteolytic mets

Ewings
sarcoma

Metadiaphysis

Aggressive periosteal
reaction
-Onion-skin
Soft tissue calcification:
<10%
Osteomyelitis
Sclerosis : 40%

Giant cell
tumor

Epiphysis

Soap-bubble sign

Infection
Metaphysis
(Osteomyeliti
s)
Ewings sarcoma

Periosteal thickening
(sometimesGiant
with Codmans
cell tumor
triangle)

Brief History
08/March
08/6/18

6/28 Plain
film

19y/o, male, suffered from soreness over right leg

was sent to hospital where distal femur
fracture was noted. Specimen was checked which
revealed osteosarcoma with pathological fracture.

7/09 MRI

08/7/1208/9/8
08/9/29
08/10/7-

received 4 courses of neoadjuvant chemotherapy

received operation for right femur OGS

received 8 courses adjuvant chemotherapy

Chest CT on 2009/07/22 showed several nodules

with calcified spot at Right lung

09/2/10

7/22 CT

09/7/22

OGS Concern
Soft tissue ossification
Medullary and cortical b
one destruction
Skip lesion
Joint involvement
Lung metastasis

2009/7/22

2009/3/31

2009/7/22

2009/3/31

2009/7/22

2009/3/31

Conclusion--Chest CT
A small nodule noted at RUL
A small nodule noted at RML
A small pleural-based nodule with calcifi
ed spot noted at RLL
No enlarged lymph node noted in the m
ediastinum

Osteogenic Sarcoma
Epidemiology: 10~20 y/0,

male prominent

The most common

primary malignant tumor

of bone for young people.

The most common sites:

metaphyses of long bones

The majority of

osteosarcomas are
sporadic, while inherited
predisposition accounts
for a minority cases.

 typically present with dull, aching pain of several mont

hs' duration that may suddenly become more severe
Night pain
frequently have a history of a minor injury, sprain or
muscle pull incurred while participating in a sport

Treatment
Wide excision or amputation
Effective chemotherapy
Neoadjuvant C/T +surgery + adjuvant C/T
5-year survival rate: 60~80%
Most common C/T agents
Ifosfamide / Doxorubicin
High-dose MTX/ Cisplatin

References
Osteogenic sarcoma- Radiology Reference Article | Rad
iopaedia.org
American Family Physician- Osteosarcoma: A Multidisci
plinary Approach to Diagnosis and Treatment
http://www.aafp.org/afp/2002/0315/p1123.html#afp2
0020315p1123-t2
http://www.radiologyassistant.nl/en/p494e15cbf0d8d
A Concise Textbook of Radiology, Peter Armstrong and
Martin L. Wastie.
, R.C.Bittner, R. Rossdeutscher

Thanks for your attention!