Young adult presented with gradually increasing swelling and pain in the right leg for 5 months.
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There is a large soft tissue mass in the right leg below the knee.
The right fibula shows extensive and aggressive long segment periosteal reaction along the proximal diaphsis which is perpendicular to the shaft, forming Codman triangle and extends perpendicularly from the inner cortex to the outer margin of the tumour. There is cortical erosion and cortical thickening suggestive of possible intramedullary extension.
Malignant periosteal reaction, Codman triangle, cortical erosion and thickening. In view of the age of the patient, imaging features are suggestive of periosteal osteosarcoma. Differential diagnosis include a high grade surface osteosarcoma.
Periosteal osteosarcoma is the second most common type of juxtacortical osteosarcoma after parosteal osteosarcoma accounting for 1.5% of all osteosarcomas. Patients typically present in the 2nd or 3rd decade of life, with a characteristic location along the diaphyses of long bones, most commonly the tibia.