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__NOTOC__
__NOTOC__
{{CMG}}
 
{{CMG}}; {{AE}}[[User:DrMars|Mohammadmain Rezazadehsaatlou[2]]]
{{Osteosarcoma}}
{{Osteosarcoma}}
==Overview==
==Overview==
On x-ray, osteosarcoma is characterized by medullary and cortical bone destruction, periosteal reaction, tumor matrix [[calcification]] and soft tissue mass.<ref name=radio2> Osteosarcoma. Dr Amir Rezaee ◉ and Dr Frank Gaillard ◉ et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/osteosarcoma</ref>
On [[X-ray]], [[osteosarcoma]] is characterized by [[medullary]] and [[cortical bone]] destruction, [[periosteal reaction]], tumor matrix [[calcification]], and soft tissue mass.


==X Ray==
==X Ray==
Conventional radiography continues to play an important role in diagnosis of osteosarcoma. Typical appearances of conventional high grade osteosarcoma include:<ref name=radio2> Osteosarcoma. Dr Amir Rezaee ◉ and Dr Frank Gaillard ◉ et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/osteosarcoma</ref>
Conventional radiography continues to play an important role in diagnosis of osteosarcoma. Typical appearances of conventional high grade [[osteosarcoma]] include:<ref name="radio2">Osteosarcoma. Dr Amir Rezaee ◉ and Dr Frank Gaillard ◉ et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/osteosarcoma</ref><ref name="pmid6425164">{{cite journal |vauthors=Gürtler KF, Riebel T, Beron G, Heller M, Euler A |title=[Comparison of x-ray plain films, x-ray tomograms and computed tomograms in lung nodules in children and adolescents] |language=German |journal=Rofo |volume=140 |issue=4 |pages=416–20 |date=April 1984 |pmid=6425164 |doi=10.1055/s-2008-1052998 |url=}}</ref><ref name="pmid3022331">{{cite journal |vauthors=Riebel T, Knop J, Winkler K, Delling G |title=[Comparative x-ray and nuclear medical studies of osteosarcomas to evaluate the effectiveness of preoperative chemotherapy] |language=German |journal=Rofo |volume=145 |issue=4 |pages=365–72 |date=October 1986 |pmid=3022331 |doi=10.1055/s-2008-1048952 |url=}}</ref><ref name="pmid3889998">{{cite journal |vauthors=Dinkel E, Uhl H, Roeren T |title=[Lung metastases--limitations and possibilities of radiologic diagnosis] |language=German |journal=Radiologe |volume=25 |issue=4 |pages=158–65 |date=April 1985 |pmid=3889998 |doi= |url=}}</ref><ref name="pmid7042255">{{cite journal |vauthors=Kesselring FO, Penn W |title=Radiological aspects of 'classic' primary osteosarcoma: value of some radiological investigations: A review |journal=Diagn Imaging |volume=51 |issue=2 |pages=78–92 |date=1982 |pmid=7042255 |doi= |url=}}</ref><ref name="pmid27229874">{{cite journal |vauthors=Kubo T, Furuta T, Johan MP, Adachi N, Ochi M |title=Percent slope analysis of dynamic magnetic resonance imaging for assessment of chemotherapy response of osteosarcoma or Ewing sarcoma: systematic review and meta-analysis |journal=Skeletal Radiol. |volume=45 |issue=9 |pages=1235–42 |date=September 2016 |pmid=27229874 |doi=10.1007/s00256-016-2410-y |url=}}</ref><ref name="pmid27154292">{{cite journal |vauthors=Rothermundt C, Seddon BM, Dileo P, Strauss SJ, Coleman J, Briggs TW, Haile SR, Whelan JS |title=Follow-up practices for high-grade extremity Osteosarcoma |journal=BMC Cancer |volume=16 |issue= |pages=301 |date=May 2016 |pmid=27154292 |pmc=4859955 |doi=10.1186/s12885-016-2333-y |url=}}</ref>
*Medullary and cortical bone destruction.
 
*Wide zone of transition, permeative or moth-eaten appearance.
*[[Medullary]] and [[cortical bone]] destruction.
*Aggressive periosteal reaction characterized by:
*Wide zone of [[transition]], permeative or moth-eaten appearance.
*Aggressive [[periosteal reaction]] characterized by:
:*Sunburst appearance
:*Sunburst appearance
:*[[Codman triangle]]
:*[[Codman triangle]]
:*Lamellated (onion skin) reaction: less frequently seen
:*Lamellated (onion skin) reaction: less frequently seen
*Soft-tissue mass.
*Soft-tissue mass.
*Tumor matrix ossification/[[calcification]].
*Tumor matrix [[ossification]]/[[calcification]].
:*Variable: reflects a combination of the amount of tumor bone production, calcified matrix, and [[osteoid]].
:*Variable: reflects a combination of the amount of tumor bone production, calcified matrix, and [[osteoid]].
:*Ill-defined fluffy or cloud-like cf. to the rings and arcs of chondroid lesions.
:*Ill-defined fluffy or cloud-like cf. to the rings and arcs of chondroid lesions.


[http://www.radswiki.net Images courtesy of RadsWiki]
<gallery perrow="3">
<gallery perRow="3">
File:Osteosarcoma-of-the-distal-femur.jpg
 
File:Osteosarcoma-of-the-distal-femur (1).jpg
Image:Osteosarcoma-001.jpg|Plain film: Osteosarcoma
File:Pathological-femur-fracture (1).jpg
Image:Osteosarcoma-002.jpg|Plain film: Osteosarcoma
File:Pathological-femur-fracture.jpg
File:Osteosarcoma-of-the-fibula (1).jpg
File:Osteosarcoma-of-the-fibula.jpg
</gallery>
</gallery>


===Extra skeletal osteosarcoma===
*The following table illustrates the findings on x-ray for the subtypes of osteosarcoma:<ref name="radio2">Osteosarcoma.Radiopaedia.org 2015. http://radiopaedia.org/search?utf8=%E2%9C%93&q=osteosarcoma&scope=all</ref>
On X-ray, extra skeletal osteosarcoma appears as soft tissue density with variable amount of [[calcification]] which represents [[osteoid]] matrix formation, and is seen in approximately 50% of cases.


===Parosteal osteosarcoma===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Subtype}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|X-Ray findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Intracortical osteosarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents as an oval intracortical geographic osteolytic lesion in the diaphysis with surrounding sclerosis.
*Measures approximately 4 cm in length.
*Multiple calcific foci can be seen within the lytic region, suggesting osteoid matrix.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Parosteal osteosarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Large lobulated exophytic, 'cauliflower-like' mass with central dense ossification adjacent to the bone.
*Large lobulated exophytic, 'cauliflower-like' mass with central dense ossification adjacent to the bone.
*'''String sign''': Thin radiolucent line separating the tumor from cortex, observed in 30% of cases.
*String sign: Thin radiolucent line separating the tumor from cortex, observed in 30% of cases.
*Tumor stalk: Grows within tumor in late stages and obliterates the radiolucent cleavage plane.
*Tumor stalk: Grows within tumor in late stages and obliterates the radiolucent cleavage plane.
*+/- soft tissue mass.
*+/- soft tissue mass.
*Cortical thickening without aggressive periosteal reaction is often seen.
*Cortical thickening without aggressive periosteal reaction is often seen.
*Tumor extension into medullary cavity is frequently observed.
*Tumor extension into medullary cavity is frequently observed.
 
|-
===Intracortical osteosarcoma===
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
*It typically presents as an oval intracortical geographic osteolytic lesion in the [[diaphysis]] with surrounding [[sclerosis]] and usually measures about 4 cm in length. *Multiple calcific foci can be seen within the lytic region, suggesting osteoid matrix.
:Periosteal osteosarcoma
 
| style="padding: 5px 5px; background: #F5F5F5;" |
===Periosteal osteosarcoma===
*Typically seen as a broad-based surface soft-tissue mass causing extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into the soft-tissue component.
*Typically seen as a broad-based surface soft-tissue mass causing extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into the soft-tissue component.
 
|-
===Low grade osteosarcoma===
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
*Because the [[fibrous dysplasia]] and central low-grade osteosarcoma are so similar histologically, the radiographic features are an extremely important part of the diagnosis.
:Telangiectatic osteosarcoma
*Radiographic features of low grade osteosarcomas are variable.
| style="padding: 5px 5px; background: #F5F5F5;" |
*Most common pattern is as a large intracompartmental expansile lytic fibro-osseous lesion with coarsely thick or thin incomplete trabeculations. Another less common pattern is as a dense sclerotic lesion.
*Cortical erosion and soft tissue extension is also a common feature.
 
===Telangiectatic osteosarcoma===
*Typically seen as an expansile lytic metaphyseal bony lesion.
*Typically seen as an expansile lytic metaphyseal bony lesion.
*Geographic bony destruction with wide zone of transition tends to be more common than permeative bony destruction.
*Geographic bony destruction with wide zone of transition tends to be more common than permeative bony destruction.
*Less osteoid matrix compared from conventional type.
*Less osteoid matrix compared to conventional type.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Low grade osteosarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Because the [[fibrous dysplasia]] and central low-grade [[osteosarcoma]] are so similar histologically, the radiographic features are an extremely important part of the diagnosis.
*Radiographic features of low-grade osteosarcomas are variable.
*Most common pattern is as a large intracompartmental expansile lytic fibro-osseous lesion with coarsely thick or thin incomplete trabeculations. Another less common pattern is as a sclerotic lesion.
*Cortical [[Erosion (dental)|erosion]] and soft tissue extension is also a common feature.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Extra skeletal osteosarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Soft tissue density with a variable amount of calcification which represents osteoid matrix formation, and is seen in approximately 50% of cases.
|-
|}


==References==
==References==
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[[Category:Orthopedics]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Up-To-Date]]
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[[Category:Medicine]]
[[Category:Orthopedics]]

Latest revision as of 13:26, 17 October 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2]

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Overview

On X-ray, osteosarcoma is characterized by medullary and cortical bone destruction, periosteal reaction, tumor matrix calcification, and soft tissue mass.

X Ray

Conventional radiography continues to play an important role in diagnosis of osteosarcoma. Typical appearances of conventional high grade osteosarcoma include:[1][2][3][4][5][6][7]

  • Sunburst appearance
  • Codman triangle
  • Lamellated (onion skin) reaction: less frequently seen
  • Variable: reflects a combination of the amount of tumor bone production, calcified matrix, and osteoid.
  • Ill-defined fluffy or cloud-like cf. to the rings and arcs of chondroid lesions.
  • The following table illustrates the findings on x-ray for the subtypes of osteosarcoma:[1]
Subtype X-Ray findings
Intracortical osteosarcoma
  • Presents as an oval intracortical geographic osteolytic lesion in the diaphysis with surrounding sclerosis.
  • Measures approximately 4 cm in length.
  • Multiple calcific foci can be seen within the lytic region, suggesting osteoid matrix.
Parosteal osteosarcoma
  • Large lobulated exophytic, 'cauliflower-like' mass with central dense ossification adjacent to the bone.
  • String sign: Thin radiolucent line separating the tumor from cortex, observed in 30% of cases.
  • Tumor stalk: Grows within tumor in late stages and obliterates the radiolucent cleavage plane.
  • +/- soft tissue mass.
  • Cortical thickening without aggressive periosteal reaction is often seen.
  • Tumor extension into medullary cavity is frequently observed.
Periosteal osteosarcoma
  • Typically seen as a broad-based surface soft-tissue mass causing extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into the soft-tissue component.
Telangiectatic osteosarcoma
  • Typically seen as an expansile lytic metaphyseal bony lesion.
  • Geographic bony destruction with wide zone of transition tends to be more common than permeative bony destruction.
  • Less osteoid matrix compared to conventional type.
Low grade osteosarcoma
  • Because the fibrous dysplasia and central low-grade osteosarcoma are so similar histologically, the radiographic features are an extremely important part of the diagnosis.
  • Radiographic features of low-grade osteosarcomas are variable.
  • Most common pattern is as a large intracompartmental expansile lytic fibro-osseous lesion with coarsely thick or thin incomplete trabeculations. Another less common pattern is as a sclerotic lesion.
  • Cortical erosion and soft tissue extension is also a common feature.
Extra skeletal osteosarcoma
  • Soft tissue density with a variable amount of calcification which represents osteoid matrix formation, and is seen in approximately 50% of cases.

References

  1. ↑ 1.0 1.1 Osteosarcoma. Dr Amir Rezaee ◉ and Dr Frank Gaillard ◉ et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/osteosarcoma
  2. ↑ Gürtler KF, Riebel T, Beron G, Heller M, Euler A (April 1984). "[Comparison of x-ray plain films, x-ray tomograms and computed tomograms in lung nodules in children and adolescents]". Rofo (in German). 140 (4): 416–20. doi:10.1055/s-2008-1052998. PMID 6425164.
  3. ↑ Riebel T, Knop J, Winkler K, Delling G (October 1986). "[Comparative x-ray and nuclear medical studies of osteosarcomas to evaluate the effectiveness of preoperative chemotherapy]". Rofo (in German). 145 (4): 365–72. doi:10.1055/s-2008-1048952. PMID 3022331.
  4. ↑ Dinkel E, Uhl H, Roeren T (April 1985). "[Lung metastases--limitations and possibilities of radiologic diagnosis]". Radiologe (in German). 25 (4): 158–65. PMID 3889998.
  5. ↑ Kesselring FO, Penn W (1982). "Radiological aspects of 'classic' primary osteosarcoma: value of some radiological investigations: A review". Diagn Imaging. 51 (2): 78–92. PMID 7042255.
  6. ↑ Kubo T, Furuta T, Johan MP, Adachi N, Ochi M (September 2016). "Percent slope analysis of dynamic magnetic resonance imaging for assessment of chemotherapy response of osteosarcoma or Ewing sarcoma: systematic review and meta-analysis". Skeletal Radiol. 45 (9): 1235–42. doi:10.1007/s00256-016-2410-y. PMID 27229874.
  7. ↑ Rothermundt C, Seddon BM, Dileo P, Strauss SJ, Coleman J, Briggs TW, Haile SR, Whelan JS (May 2016). "Follow-up practices for high-grade extremity Osteosarcoma". BMC Cancer. 16: 301. doi:10.1186/s12885-016-2333-y. PMC 4859955. PMID 27154292.

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