12-year-old patient with bone pain



Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian


Case Section

Muskuloskeletal System


Patient's Information

Gender : Female
Age : 12


Clinical Summary

12-year-old patient with bone pain


Imaging Findings

MR images demonstrate heterogeneous mass arising from the surface of the diaphysis of the right femur which surrounds posterior and bilateral aspects of femur.There are focal cortical destruction associated with focal intramedullary extension. The mentioned mass is predominantly low signal on T1- and intermediate to high signal on T2-weighted images and enhances significantly.The mass contains areas of low signal intensity on both T1- and T2-weighted images consistent with fluffy mineralization.Periosteal reaction and bone marrow signal changes are also seen.


Differential Diagnosis

1.Osteosarcoma,2,Ewing sarcoma,3.Soft tissue sarcoma


Final Diagnosis

High-grade surface osteosarcoma


Discussion (Related Text)

Osteosarcoma (OS) is a common primary malignant tumor of bone that produces osteoid matrix. According to the World Health Organization, OS of bone is classified into eight subtypes with distinct biologic behaviors and clinical outcomes: conventional, telangiectatic, small cell, low-grade central, secondary, parosteal, periosteal, and high-grade surface. Imaging plays a crucial role in the diagnosis of each subtype of OS and ultimately in patients’ survival because the diagnosis is based on a combination of histopathologic and imaging features. Conventional OS is the most common subtype of OS and is readily identified at radiography as an intramedullary mass with immature cloudlike bone formation in the metaphyses of long bones. The imaging features of less common subtypes of primary OS are variable and frequently overlap with those of multiple benign and malignant entities, creating substantial diagnostic challenges. For accurate diagnosis, it is important to be aware of radiographic and cross-sectional imaging features that allow differentiation of each nonconventional subtype of OS from its mimics.



RadioGraphics 2010; 30:1653–1672


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