PMC3585775_01
X-ray showing pure, patchy osteosclerotic lesions of (A) distal femurs, (B) proximal tibiae, and (C) hip bones, ilium, sacrum, and proximal femurs. Bony destruction is likely evident in the right distal femur and appears to be surrounded by a patchy periosteum reaction.
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On February 11, 2011, a 14-year-old male initially presented with pain in the right thigh muscle without trauma and was subsequently found to have purely osteosclerotic lesions of the skull, vertebrae, ribs, bilateral and nearly symmetric proximal humerus, pelvis, ilium, sacrum, proximal and distal femurs, and proximal tibiae (Figs. 1 and 2).
An (A) anterior and (B) posterior bone scan showing multiple foci in the skull, vertebrae, ribs, bilateral and nearly symmetric proximal humerus, pelvis, ilium, sacrum, proximal and distal femurs, and proximal tibiae with abnormal bone uptake.
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F0002
On February 11, 2011, a 14-year-old male initially presented with pain in the right thigh muscle without trauma and was subsequently found to have purely osteosclerotic lesions of the skull, vertebrae, ribs, bilateral and nearly symmetric proximal humerus, pelvis, ilium, sacrum, proximal and distal femurs, and proximal tibiae (Figs. 1 and 2).
MRI of the left knee showing marked flakes and nodular long signals on T2-weighted MRI in the distal femur, proximal tibia, and even the osteoephysis.
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The lesions were particularly evident in the right distal femur (Fig. 3).
Hematoxylin and eosin (H&E) staining (magnificationx100) indicates tumor cells producing osteoid.
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An open bone biopsy was performed on the bilateral distal femora and proximal tibiae, and four foci were found that exhibited mid-grade osteoblastic osteosarcoma (Fig. 4).
Thoracolumbar MRI (A) shows a short signal on T2-weighted MRI in the T2 to T11, L1 to L5, and sacral vertebra. (B, C) Flake low signal shadows are observed outside of the spinal cord and dura in the T4-T5 and T9-T10 spinal body plane. MRI taken after neoadjuvant chemotherapy (A) indicated that the number of lesions increased and the tumors in the spinal canal were amplified, as compared to that taken before treatment (B, C).
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In comparison to the previous MRI (Fig. 5B and C), the number of lesions had increased and the tumors in the spinal canal were amplified after the neoadjuvant chemotherapy (Fig. 5A).