“ Most common primary bone tumour in children and adolescents; overall, second most common primary bone tumour after myeloma. There is a se...
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Most common primary bone tumour in children and adolescents; overall, second most common primary bone tumour after myeloma. There is a second peak between 70 and 80 years of age due to malignant transformation of Paget disease (i.e. secondary osteosarcoma).
‘Conventional’ primary osteosarcoma is most common; other subtypes include small cell, telangiectatic, low-grade central osteosarcoma and surface types (parosteal, periosteal, etc.). Treatment is a combination of surgery and chemotherapy.
CHEST X-RAY
• Check for lung metastases (may be dense).
APPENDICULAR X-RAY
• Ill-defined lytic/sclerotic metaphyseal lesion in the distal femur or anteromedial tibia.
• Internal osteoid matrix (characteristic and needed for a histological diagnosis).
• Florid, aggressive periostitis—sunburst, ‘hair on end’ or Codman’s triangle.
• Soft tissue mass containing speckles of calcification.
• Telangiectatic osteosarcoma mimics an ABC or GCT.
MRI
• Lesion is high signal on T2 and contains foci of high signal on T1 (haemorrhage).
Osteosarcoma. Frontal radiograph of the left knee demonstrating an ill-defined lytic/sclerotic lesion within the metaphyseal region of the proximal tibia. There is a florid periostitis with Codman’s triangle identified (white arrow).
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