Case report Osteogenic Sarcoma

Case reportOsteogenic Sarcoma OGStype

1Patient ProfilePatient Information3606079-4O19 y/o maleChief complaintsoreness over right leg since March 2008sport injury, received rehabilitation on LMDLeg broke while he was standing wearing his socks on 2008/6/18Past HistoryNo special historyBrief History08/March08/6/18

08/7/12- 08/9/808/9/29

08/10/7-09/2/10

09/7/22

19y/o, male, suffered from soreness over right legwas sent to hospital where distal femur fracture was noted. Specimen was checked which revealed osteosarcoma with pathological fracture.

received 4 courses of neoadjuvant chemotherapy

received operation for right femur OGS

received 8 courses adjuvant chemotherapy

Chest CT on 2009/07/22 showed several nodules with calcified spot at Right lung7/22 CT 6/28 Plain film7/09 MRI3OGS ConcernSoft tissue ossificationMedullary and cortical bone destructionSkip lesionJoint involvementLung metastasis

4

osteolytic lesions with permeative marginSoft tissue ossification08/06/28 Plain filmPeriosteal reactionPeriosteal reactionMedulla ossification5Periosteal reaction

Conclusion-Plain FilmPathologic fracture at distal femur with displacement and soft tissue swelling.Soft tissue ossification: Sunburst signOsteolytic lesions: ill-definedPeriosteal reactionOGS ConcernSoft tissue ossificationMedullary and cortical bone destructionSkip lesionJoint involvementLung metastasis

8Brief History08/March08/6/18

08/7/12- 08/9/808/9/29

08/10/7-09/2/10

09/7/22

19y/o, male, suffered from soreness over right legwas sent to hospital where distal femur fracture was noted. Specimen was checked which revealed osteosarcoma with pathological fracture.

received 4 courses of neoadjuvant chemotherapy

received operation for right femur OGS

received 8 courses adjuvant chemotherapy

Chest CT on 2009/07/22 showed several nodules with calcified spot at Right lung7/22 CT 6/28 Plain film7/09 MRI9

08/07/09MRI STIR/T1/T2Subcutaneous + soft tissue edemaBone edemaLow signal massinvolving soft tissue and bone medullaCorticalbreakthroughInternal hemorrhage

Post-contrast

Axial T1+ CNeurovascular bundle~~~12Conclusion-MRIDiaphysis of RT distal femur, 8.3 x10.3 cm in sizeInternal hemorrhagePathological fracture and displacementPeriosteal reactionThe mass showed post contrast heterogeneous enhancement, evident necrosis of central portion, viable tumor portion was mainly at marginSurrounding soft tissue edemaThe joint was spared.Neurovascular bundle compressed No definite skip metastasis (STIR)

Differential diagnosis

OsteosarcomaMetaphysisSoft tissue involvementAggressive periosteal reaction -Sunburst type -Codman triangle Ewings sarcoma

Metadiaphysis

Aggressive periosteal reaction -Onion-skinSoft tissue calcification: