Osteosarcoma of femur

Case contributed by Dr Domagoj Kretic

Presentation

11 year old girl presented with thigh pain after volleyball practice.

Patient Data

Age: 11
Gender: Female
Ultrasound

US of quadriceps muscle showed unremarkable structure of muscle and quadriceps tendon.

Further investigation, with inspection of medial parts of thigh showed irregular cortical line of left femur metaphysis with some hyperechogenic expansile soft tissue mass, which is fairly vascularized.

X-ray

Radiographic images of left femur.

In distal third of left femur diaphysis, mostly medial and dorsal, there are signs of aggressive periostitis.

Inside of medullary bone there is mixed sclerotic and lytic areas, with wide zone of transition and cortical destruction.

MRI

MRI (SSG protocol):

Mixed mosaic lesion infiltrating almost whole circumference of medullary bone, with cortical destruction and extensive soft tissue component, which is situated mostly dorsal.

There is strong contrast enhancement of lesion, especially of the soft tissue component.

Case Discussion

After MRI was done and differential concluded osteosarcoma or Ewing's sarcoma, patient underwent a biopsy of soft tissue component.

Result came back as osteosarcoma.

Patient is now receving radiation treatment and chemotherapy, after which surgical excision will be done, with care to save knee and femoral epiphyseal growth plate.

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Case information

rID: 33416
Published: 15th Jan 2015
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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