Pelvic osteosarcoma

Case contributed by Dr Craig Hacking

Presentation

Bone pain.

Patient Data

Age: 69
Gender: Male
X-ray

Extensive destructive sclerosis in the right pubic rami and ischium with pathological fracture of the superior pubic ramus. There is an associated soft tissue mass extending into the pelvis and displacing phleboliths and the bowel. 

Appearances are aggressive and would be atypical for metastasis and may represent a primary bony tumour such as an osteosarcoma. Correlation with CT and MRI required.

Right DHS with partially imaged.

CT

Artefact from right DHS degrades diagnostic quality. There is destruction, expansion and sclerosis of the right superior and inferior pubic rami, pubic body and ischium, extending into the acetabulum. An associated soft tissue mass involves pectineus, obturator internus and obturator externus

There are innumerable bilateral pulmonary nodules. Background emphysema. No pleural or pericardial effusion. No lymphadenopathy within the chest.

Bilateral low density renal lesions may represent cysts- this could be confirmed on ultrasound. The abdominal viscera are otherwise unremarkable. Right common and external iliac lymph nodes are prominent but not enlarged according to size criteria. Conclusion

Appearance is favoured to represent a right pelvic osteosarcoma with pulmonary metastases. Pelvic and osseous metastatic disease from an unidentified remote primary is a less likely possibility.

MRI

Image quality is markedly degraded by motion artefact as well as artefact arising from the right femoral DHS.

Aggressive tumour replaces the right inferior and superior pubic rami. Extensive infiltration of the right hemipelvis with regions of appreciable contrast enhancement in the right acetabulum, iliac wing and right posterior superior iliac spine abutting the sacroiliac joint. There is a large soft tissue mass encasing the right superior pubic ramus and pubic body and extending into the right lateral pelvic wall medial to the acetabulum.

Conclusion

Artefact degraded study demonstrates large ossifying expansile tumour of the right pubic bone, with satellite lesions in the ilium and ischium, consistent with osteosarcoma. Sacrum and left pelvic bone appears clear.

Case Discussion

Good case of secondary osteosarcoma. The patient had a history of minor right hemipelvic Paget's disease.

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Case information

rID: 36810
Case created: 12th May 2015
Last edited: 3rd Sep 2015
Inclusion in quiz mode: Included

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