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