Images of Musculoskeletal Oncology - E.R. Mindell, M.D.
Conventional osteogenic sarcoma
N.A. Teenage girl with mild pain, swelling, and limp for 2 months? (Need more specific
information.)
3395.26 These are routine radiographs of the destructive and bone forming lesion in her
3395.27 distal femoral metaphysis. The lesion has rather indistinct and subtle borders
3513.28 and appears to be a serious lesion.
This is a MRI that more clearly outlines the bone lesion. (Note: the biopsy
3395.25 should be done only after staging studies like this MRI to avoid introducing the
artifacts of the biopsy.)
3595.32
This total body bone scan demonstrates increased uptake of isotope only in the
distal femoral lesion. Chest x-ray was normal.
Open biopsy was done which demonstrate the high grade osteosarcoma with
3395.10 pleomorphic nuclei and the tumor new bone. Note the variation in the tissue
3395.8 from small to large amounts of tumor bone. Tumor has spread laterally outside
3513.10 the bony compartment. The diagnosis of Osteogenic Sarcoma IIB was made.
(That is high grade tumor spread outside the bony compartment).
3395.1
The patient was started on appropriate chemotherapy 2 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 and demonstrates the well
3395.28 defined metaphyseal border and what appears to be penetration of the
epiphyseal plate laterally.
3395.15
This photograph demonstrates the widely resected tumor including the biopsy
site.
3395.31 This specimen radiograph confirms the wide resection.
3513.20
This photo 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
3513.25 lateral portion of the epiphyseal plate. The plate is limiting the spread to some
extent.
3513.8
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.
3513.3
Histosection of necrotic neoplasm seen in the resected specimen. Note the
acellularity.
3513.7
High power histology demonstrates epiphyseal penetration by tumor. The
metaphysis is on your right.
3513.27 Reconstruction was by prosthetic distal femur and total knee joint with a good
3513.29 immediate result.
Learning Issues:
1. MRI is very useful in determining extent and boundaries of an osteogenic
sarcoma.
2. Epiphyseal plate may act as a barrier to further spread of conventional osteogenic
sarcoma for some time.
Need follow-up, such as chart and final x-rays. Phone her.
Images of Musculoskeletal Oncology
University at Buffalo Department of Orthopaedics