IS Case 610: Metastatic osteosarcoma to the chest
Imaging Sciences URMC 2011
Publication Date: 2011-12-12
The patient is an 18-year-old female, with history of osteosarcoma involving the distal right femur status post wide excision limb salvage procedure and adjuvant chemotherapy, presenting with hemoptysis.
Right distal femur osteosarcoma involving the medial metaphysis. Left hilar mass with ossification and calcification consistent with metastatic osteosarcoma.
Metastatic osteosarcoma to the chest
Osteosarcomas are amongst the most common primary malignant bone tumors. Hallmark clinical presenting features include persistent pain, tenderness, and swelling of a skeletal part. Patient’s may also present with pathologic fractures. Most commonly osteosarcoma affects the adolescent age group. Typical sites of predilection are the distal femur, proximal tibia, and proximal humerus. The most frequent complications of high grade primary osteosarcoma are pathologic fracture and the development of pulmonary metastases.
“Distinctive radiographic features of osteosarcoma include: medullary and cortical bone destruction (moth eaten or permeative), aggressive periosteal reaction (sunburst appearance and Codman’s triangle), soft tissue mass. Tumors may present as purely sclerotic, purely osteolytic or a combination of both. The borders are indistinct with a wide zone of transition.” 
Treatment options depend on the feasibility of resection. Limb salvage procedures or amputations with subsequent adjuvant chemotherapy results in 5 year survival rates of 60%.
Osteosarcoma has a hematogeneous spread pattern resulting in common metastases to the lungs and liver. Osseous metastases are also possible however occur at a lower frequency than pulmonary or hepatic metastases. Nuclear medicine bone scanning is a helpful technique for immediate staging and follow up.
“Because osteosarcomas are bone-forming lesions, soft tissue metastases may be seen as foci of extraskeletal increased activity, especially in the liver and lung.” 
- Mettler FA Jr, Guiberteau MJ. Essentials of Nuclear Medicine Imaging. Fifth Edition. Saunders, 2005:254.
- Greenspan A. Orthopaedic Imaging: A Practical Approach. Fourth Edition. Lippincott Williams & Wilkins, 2004:691-692.