Osteosarcoma in Paget disease

Case contributed by Melbourne Uni Radiology Masters
Diagnosis certain


Left hip pain

Patient Data

Age: 75 years
Gender: Male

CT Abdomen and pelvis


Lower lumbar spine and pelvic Paget disease, left hemipelvis worse than right. In the left ilium, along the pelvic surface, enlarging enhancing soft tissue mass is again demonstrated with associated periosteal new bone formation. This has increased from 6.4 x 1.7 x 7.7 cm (2 years ago) to 7.5 x 2.4 x 9.9 cm (6 months ago) to currently 8 x 2.6 x 11 cm.

Conclusion: Enlarging soft tissue mass related to Paget disease of the left hemipelvis remains concerning for sarcomatous transformation. Metastasis is felt less likely. No other potential sites of metastatic disease.

Case Discussion

Biopsy proven osteosarcoma

Secondary development of osteosarcoma in Paget occurs in ≈1% of cases and is often highly resistant to treatment. 

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