Periosteal osteosarcoma

Case contributed by Yasser Asiri
Diagnosis almost certain


Pain in the mid right thigh.

Patient Data

Age: 16 years
Gender: Male

Distal right femoral metadiaphysis lesion with wide zone of transition, aggressive sunburst periosteal reaction and soft tissue component with osteoid matrix. No pathological fracture. No other lesions seen. 


On MRI, the soft tissue lesion encases the anterior aspect of the distal femoral metaphysis and associated with cortical thinning and erosion. It demonstrates isointense signal on T1 and heterogeneous signal on T2 with central component of intermediately low T2 signal intensity likely related to the dense osteoid matrix. Peripheral avid enhancement is noted. Perilesional edema and mild diffuse intramedullary bone marrow edema are seen. The constellation of findings are most likely representing periosteal osteosarcoma.

Case Discussion

Periosteal osteosarcoma is a rare form of osteosarcoma arising from the inner periosteum and usually located in the diaphysis. On imaging, the mass usually shows cortical thinning, aggressive periosteal reaction and associated soft tissue component. 

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