Presentation
Painful right thigh swelling for 8 months.
Patient Data
Mixed bone lesion with osteoblastic predominance in the middle and distal third of the right femur, with an osteolytic component with imprecise limits in the proximal third, extending to the level of the small femoral trochanter. There is cortical disruption and aggressive multilamellar periosteal reaction ("onion skin"), "sunburst" reaction, Codman triangle, and bone formation at adjacent soft tissues.
Extensive lesion involving the entire right femoral bone compartment, expansive and infiltrative, with areas of low signal on T1 and heterogeneous high signal on T2, with contrast uptake. The lesion breaks through the cortical bone and infiltrates adjacent soft tissues and involves the popliteal neurovascular bundle. Note the area of subcutaneous infiltration in the medial and distal portion of the thigh.
Case Discussion
Osteosarcoma is the most prevalent primary malignant bone neoplasm under 18 years of age.
Radiologically, it is characterized by an ill-defined mixed bone lesion, with a predominance of an osteoblastic component. Most cases present with an extra-compartmental bone component with an aggressive complex periosteal reaction (sunburst) and/or multilamellar (onion skin) type.
Local bone staging with MRI imaging should always study the entire compartment, with the aim of understanding the intracompartmental extension of the disease.
A core needle biopsy was performed and the diagnosis confirmed: osteoblastic osteosarcoma. The patient was referred to intensive oncological treatment, and local control of the disease was performed with hip disarticulation.
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