Metastatic osteosarcoma

Case contributed by Reza Sadeghi
Diagnosis certain

Presentation

Leg swelling following chronic bone pain.

Patient Data

Age: 11 years
Gender: Male
x-ray
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Info

There is a large ill-defined sclerotic area in distal half of tibia with typical aggressive sunburst periosteal reaction along with new bone formation in soft tissue.

mri
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Axial
T1
This study is a stack
Coronal
T1
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Sagittal
T1
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Axial
Gradient Echo
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Axial
Gradient Echo
This study is a stack
Coronal
Gradient Echo
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Sagittal
Gradient Echo
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Axial
DWI
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Axial
ADC
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Axial T1
C+ fat sat
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Coronal T1
C+ fat sat
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Axial T1
fat sat
This study is a stack
Axial
T2
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Info

The inhomogeneous intramedullary lesion of distal half of tibia along with a large soft tissue component in distal third which circumferentially overlies the cortical destruction are seen. The mentioned lesion penetrates the growth plate distally and involves the tibial nerve, also. It shows postcontrast enhancement of the medullary and extraosseous components is seen.

ct
This study is a stack
Axial
non-contrast
This study is a stack
Axial
non-contrast
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Info

Typical appearance of lung metastases including multiple variable-size round pulmonary nodules with ossification foci in some of them are noted.

Case Discussion

MRI is the most accurate tool for determining the tumor extension into the medullary canal and the soft tissue. Also, the epiphyseal and neurovascular involvement and skip lesions are recognized. Correlation with X-ray in nonspecific MRI findings is helpful.

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