Osteosarcoma - distal femur

Case contributed by Hani M. Al Salam
Diagnosis almost certain

Presentation

Left thigh swelling.

Patient Data

Age: 60 years
Gender: Male
x-ray
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Info

Large mass centered on the distal femur with sunburst periosteal reaction. Distal femur is sclerotic with chronic appearing distal femoral shaft pathological fracture. 

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

CT confirms the large distal femoral mass with large extraosseous soft tissue component and spiculated periosteal reaction. Mixed lytic/sclerotic appearance of the distal femur. Pathological fracture noted. Asymmetric muscle belly atrophy and decreased bulk in both the visualized thigh and calf. 

Numerous pulmonary nodules. 

mri
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Axial
T1
This study is a stack
Axial
STIR
This study is a stack
Sagittal
STIR
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Axial
T1 C+
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Info

Large distal femoral mass with large extraosseous enhancing soft tissue component. Susceptibility artifact at the lateral aspect of the mass. Asymmetric muscle belly atrophy and decreased bulk in both the visualized thigh and calf. 

Case Discussion

Pathologically proven osteosarcoma. Lung metastases are demonstrated.

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