Citation, DOI & article data
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.
The diagnosis of periosteal osteosarcomas is based on a combination of typical radiographic features and histology.
Diagnostic criteria according to the WHO classification of bone tumors (2020 - blue book) 1:
- imaging features of a bone tumor
- histology of an intermediate-grade mostly chondroblastic osteosarcoma
- origin from the surface of the bone under the periosteum
Periosteal osteosarcomas arise from the inner germinative layer of the periosteum. The cytologic grade of this tumor is higher than parosteal osteosarcoma and lower than conventional osteosarcomas, so it is considered as intermediate grade osteosarcoma (grade 2). It predominantly contains a chondroid matrix.
- lesions tend to be diaphyseal
- femur and tibia most common, especially medial distal femur
- arises from the cortex, being attached to the 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 tend to “wrap around” the circumference of the bone
- a periosteal reaction common, as sunburst pattern (radiating from the bone surface) or a Codman triangle
- typically hypointense on both T1 and T2 sequences: may see bony spicules radiating from the surface lesion (sunburst pattern)
- it may appear hyperintense on the 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 the entire circumference of the cortex and show intramedullary extension.
Treatment and prognosis
- 1. W. H. O. Classification WHO Classification of Tumours Editorial Board, Who Classification of Tumours Editorial. Soft Tissue and Bone Tumours. (2020-04-17) ISBN: 9789283245025
- 2. Murphey M, Jelinek J, Temple H, Flemming D, Gannon F. Imaging of Periosteal Osteosarcoma: Radiologic-Pathologic Comparison. Radiology. 2004;233(1):129-38. doi:10.1148/radiol.2331030326
- 3. Grimer R, 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
- 4. deSantos L, Murray J, Barnett Finklestein J, Spjut H, Ayala A. The Radiographic Spectrum of Periosteal Osteosarcoma. Radiology. 1978;127(1):123-9. doi:10.1148/127.1.123
- 5. Yarmish G, Klein M, Landa J, Lefkowitz R, Hwang S. Imaging Characteristics of Primary Osteosarcoma: Nonconventional Subtypes. Radiographics. 2010;30(6):1653-72. doi:10.1148/rg.306105524
- 6. Manaster BJ, May DA, Disler DG. Musculoskeletal imaging. Mosby Inc. (2007) ISBN:0323043615. Read it at Google Books