Periosteal osteosarcoma is a form of surface osteosarcoma.
It is the second most common type of juxtacortical or surface osteosarcoma after parosteal osteosarcoma and accounts for 1.5% of all osteosarcoma cases. It affects a slightly older age group (10-20 years) cf. conventional osteosarcoma.
Periosteal osteosarcoma arise from the inner germinative layer of periosteum. Cytologic grade of this tumour is higher than parosteal osteosarcoma and lower than conventional osteosarcomas, so it is considered as an intermediate grade osteosarcoma (grade 2). It predominantly contains chondroid matrix.
- lesions tend to be diaphyseal
- femur and tibia most common, especially medial distal femur
- arises from cortex, being attached to underlying cortex at origin; intramedullary extension is rare
Typically seen as a broad-based surface soft-tissue mass causing extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into the soft-tissue component:
- predominantly chondroid matrix results in a lesion that is low in attenuation on CT images and hyperintense on T2 weighted MR images and tends to “wrap around” the circumference of the bone
- a periosteal reaction common, as sunburst pattern (radiating from bone surface) or a Codman triangle
- typically hypointense on both T1 and T2 sequences: may see bony spicules radiating from surface lesion (sunburst pattern)
- it may appear hyperintense on T2 sequence which represents its chondroid matrix.
- reactive marrow changes are commonly seen at MR imaging, but true marrow invasion is rare 2
- it is difficult to differentiate periosteal osteosarcoma from the conventional high grade osteosarcoma at imaging, however conventional osteosarcomas involve entire circumference of cortex and show intramedullary extension.
Treatment and prognosis
- 1. Manaster BJ, May DA, Disler DG. Musculoskeletal imaging. Mosby Inc. (2007) ISBN:0323043615. Read it at Google Books - Find it at Amazon
- 2. Murphey MD, Jelinek JS, Temple HT et-al. Imaging of periosteal osteosarcoma: radiologic-pathologic comparison. Radiology. 2004;233 (1): 129-38. doi:10.1148/radiol.2331030326 - Pubmed citation
- 3. Grimer RJ, Bielack S, Flege S et-al. Periosteal osteosarcoma--a European review of outcome. Eur. J. Cancer. 2005;41 (18): 2806-11. doi:10.1016/j.ejca.2005.04.052 - Pubmed citation
- 4. Desantos LA, Murray JA, Finklestein JB et-al. The radiographic spectrum of periosteal osteosarcoma. Radiology. 1978;127 (1): 123-9. doi:10.1148/127.1.123 - Pubmed citation
- 5. Yarmish G, Klein MJ, Landa J et-al. Imaging characteristics of primary osteosarcoma: nonconventional subtypes. Radiographics. 2010;30 (6): 1653-72. doi:10.1148/rg.306105524 - Pubmed citation
The differential diagnosis for bone tumours is dependent on the age of the patient, with a very different set of differentials for the paediatric patient.
- bone-forming tumours
- cartilage-forming tumours
- chondromyxoid fibroma
- fibrous bone lesions
- bone marrow tumours
- other bone tumours or tumour-like lesions
- aneurysmal bone cyst
- benign fibrous histiocytoma
- giant cell tumour of bone
- Gorham massive osteolysis
- haemophilic pseudotumour
- intradiploic epidermoid cyst
- intraosseous lipoma
- musculoskeletal angiosarcoma
- musculoskeletal haemangiopericytoma
- primary intraosseous haemangioma
- simple bone cyst
- impending fracture risk