Presentation
Persistent right knee pain.
Patient Data
Frontal and lateral views of the right knee demonstrate an ill-defined (wide zone of transition) lytic lesion in the distal femoral metaphysis with a small amount of sclerosis present near the lateral physis.
No appreciable periosteal reaction is seen.
MRI shows the lesion to be T1 hypointense, T2 hyperintense and avidly enhancing.
2-phase whole body bone scan shows the lesion to be hyperemic on blood pool phase and intensely osteoblastic on delayed phase.
A faint focus of abnormal radiotracer uptake in present in the right posterior calvarium that was mildly suspicious for a metastases. Further assessment at a subspecialty referral center showed no metastasis on MRI of the head/brain and FDG PET-CT.
Tissue sampling and subsequent resection at a subspecialty referral center confirmed the diagnosis of osteosarcoma.
Case Discussion
Osteosarcoma is the most common primary malignant bone tumor in pediatrics.
Imaging includes radiographs and magnetic resonance imaging for assessment of the primary lesion; as well as computerized tomography of the chest, bone scintigraphy for staging and/or FDG PET-CT for staging.
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