Secondary multifocal osteosarcoma developing on the background of bone infarct

Description

A 49-year-old-man presented to orthopaedics clinic with complaint of recently growing thigh pain. He had a history of oral and inhaler forms of steroid usage for asthma and allergy on his background. X-ray examination of the left femur showed medullary lytic lesions localised in distal diaphysis–metaphysis causing cortical destruction (figure 1). Contrast-enhanced MRI revealed medullary bone infarcts in distal diaphysis–metaphysis of the distal femur and proximal tibia bilaterally (figure 2). In this infarct area, there were multiple lesions causing cortical destructions with soft tissue components, and showing prominent enhancement on postcontrast images. The largest one is measured 4x2.5 cm. Multiple smaller lesions which were presenting similiar imaging characteristics without soft tissue components were also seen. Histological evaluation revealed the diagnosis of osteosarcoma.

Figure 1

(A, B) X-ray examination of the left femur showed the medullary lytic lesions (arrows) localised in distal diaphysis–metaphysis causing cortical...

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