IS Case 598: Osteosarcoma with large cannonball pulmonary metastases

Mike Nguyen, MD

Imaging Sciences URMC

Imaging Sciences URMC 2010
Publication Date: 2011-11-17


The patient is a 28-year-old male who initially presented at outside hospital with a tibial fracture while playing basketball 18 months ago. Imaging at that time showed a tumor of his proximal right tibia as the cause of his pathological fracture. Biopsy demonstrated osteosarcoma. Thoracic imaging demonstrated that the osteosarcoma metastasized to his lungs. His pulmonary metastases rapidly progressed despite chemotherapy and radiotherapy.


Osteosarcoma and large “cannonball” pulmonary metastases.


Osteosarcoma with large "cannonball" pulmonary metastases


Osteosarcoma represents 20% of all primary bone malignancies and is the most common malignant primary bone tumor in young adults and children. Radiologic features include medullary and cortical bone destruction, aggressive periosteal reaction, and soft-tissue mass containing tumor bone. Osteosarcoma metastasizes approximately 15-20% of cases and the lungs are the most common site (85%). When the pulmonary metastases are large and round, they are termed “cannonball” because their appearance resemble these objects. Other primary tumors that often present with pulmonary metastases include renal cell carcinoma, breast cancer, prostate cancer, and colorectal cancer.

The overall survival rate for osteosarcoma with metastatic disease is 10-30% which has a significantly poorer prognosis compared to localized osteosarcoma which has a 60-70% survival rate.


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  2. Rasalkar DD, Chu WC, Lee V, Paunipagar BK, Cheng FW, Li CK. Pulmonary metastases in children with osteosarcoma: characteristics and impact on patient survival. Pediatr Radiol. 2011 Feb;41(2):227-36. PMID: 20814672

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