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Pediatrics
Diagnosis
Musculoskeletal
Focal, Multifocal, and Diffuse Bone Lesions
Osteosarcoma
Osteosarcoma
Christopher G. Anton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Osteogenic sarcoma, conventional osteosarcoma

          • Definitions

            • Osteosarcoma (OS): Malignant tumor with ability to produce osteoid directly from neoplastic cells

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Habre C et al: Diffusion-weighted imaging in differentiating mid-course responders to chemotherapy for long-bone osteosarcoma compared to the histologic response: an update. Pediatr Radiol. 51(9):1714-23, 2021
                                              2. Parlak Ş et al: Diffusion-weighted imaging for the differentiation of Ewing sarcoma from osteosarcoma. Skeletal Radiol. 50(10):2023-30, 2021
                                              3. Tal AL et al: The utility of 18FDG PET/CT versus bone scan for identification of bone metastases in a pediatric sarcoma population and a review of the literature. J Pediatr Hematol Oncol. 43(2):52-8, 2021
                                              4. Liu F et al: Effectiveness of 18F-FDG PET/CT in the diagnosis and staging of osteosarcoma: a meta-analysis of 26 studies. BMC Cancer. 19(1):323, 2019
                                              5. Spraker-Perlman HL et al: Factors influencing survival after recurrence in osteosarcoma: a report from the Children's Oncology Group. Pediatr Blood Cancer. 66(1):e27444, 2019
                                              6. Takeuchi A et al: Joint-preservation surgery for pediatric osteosarcoma of the knee joint. Cancer Metastasis Rev. 38(4):709-22, 2019
                                              7. Harrison DJ et al: Current and future therapeutic approaches for osteosarcoma. Expert Rev Anticancer Ther. 18(1):39-50, 2018
                                              8. Sharp SE et al: FDG PET/CT appearance of local osteosarcoma recurrences in pediatric patients. Pediatr Radiol. 47(13):1800-8, 2017
                                              9. Anderson ME: Update on survival in osteosarcoma. Orthop Clin North Am. 47(1):283-92, 2016
                                              10. Fidler MM et al: Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study. Br J Cancer. 112(12):1857-65, 2015
                                              11. Isakoff MS et al: Osteosarcoma: current treatment and a collaborative pathway to success. J Clin Oncol. 33(27):3029-35, 2015
                                              12. Muheremu A et al: Positron emission tomography/computed tomography for bone tumors (Review). Oncol Lett. 9(2):522-6, 2015
                                              13. Salah S et al: Factors predicting survival following complete surgical remission of pulmonary metastasis in osteosarcoma. Mol Clin Oncol. 3(1):157-62, 2015
                                              14. Ferrari S et al: Nonmetastatic osteosarcoma of the extremity. Neoadjuvant chemotherapy with methotrexate, cisplatin, doxorubicin and ifosfamide. An Italian Sarcoma Group study (ISG/OS-Oss). Tumori. 100(6):612-9, 2014
                                              15. Lee JS et al: Secondary malignant neoplasms among children, adolescents, and young adults with osteosarcoma. Cancer. 120(24):3987-93, 2014
                                              16. Subhawong TK et al: Diffusion-weighted MR imaging for characterizing musculoskeletal lesions. Radiographics. 34(5):1163-77, 2014
                                              17. Guo J et al: Dynamic contrast-enhanced magnetic resonance imaging as a prognostic factor in predicting event-free and overall survival in pediatric patients with osteosarcoma. Cancer. 118(15):3776-85, 2012
                                              18. Kaste SC: Imaging pediatric bone sarcomas. Radiol Clin North Am. 49(4):749-65, vi-vii, 2011
                                              19. Jawad MU et al: In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system. Clin Orthop Relat Res. 468(7):2000-2, 2010
                                              20. Hayashida Y et al: Monitoring therapeutic responses of primary bone tumors by diffusion-weighted image: initial results. Eur Radiol. 16(12):2637-43, 2006
                                              21. Bacci G et al: Prognostic significance of serum lactate dehydrogenase in osteosarcoma of the extremity: experience at Rizzoli on 1421 patients treated over the last 30 years. Tumori. 90(5):478-84, 2004
                                              22. Kaste SC et al: Tumor size as a predictor of outcome in pediatric non-metastatic osteosarcoma of the extremity. Pediatr Blood Cancer. 43(7):723-8, 2004
                                              23. Sajadi KR et al: The incidence and prognosis of osteosarcoma skip metastases. Clin Orthop Relat Res. (426):92-6, 2004
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Osteogenic sarcoma, conventional osteosarcoma

                                                      • Definitions

                                                        • Osteosarcoma (OS): Malignant tumor with ability to produce osteoid directly from neoplastic cells

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Habre C et al: Diffusion-weighted imaging in differentiating mid-course responders to chemotherapy for long-bone osteosarcoma compared to the histologic response: an update. Pediatr Radiol. 51(9):1714-23, 2021
                                                                                          2. Parlak Ş et al: Diffusion-weighted imaging for the differentiation of Ewing sarcoma from osteosarcoma. Skeletal Radiol. 50(10):2023-30, 2021
                                                                                          3. Tal AL et al: The utility of 18FDG PET/CT versus bone scan for identification of bone metastases in a pediatric sarcoma population and a review of the literature. J Pediatr Hematol Oncol. 43(2):52-8, 2021
                                                                                          4. Liu F et al: Effectiveness of 18F-FDG PET/CT in the diagnosis and staging of osteosarcoma: a meta-analysis of 26 studies. BMC Cancer. 19(1):323, 2019
                                                                                          5. Spraker-Perlman HL et al: Factors influencing survival after recurrence in osteosarcoma: a report from the Children's Oncology Group. Pediatr Blood Cancer. 66(1):e27444, 2019
                                                                                          6. Takeuchi A et al: Joint-preservation surgery for pediatric osteosarcoma of the knee joint. Cancer Metastasis Rev. 38(4):709-22, 2019
                                                                                          7. Harrison DJ et al: Current and future therapeutic approaches for osteosarcoma. Expert Rev Anticancer Ther. 18(1):39-50, 2018
                                                                                          8. Sharp SE et al: FDG PET/CT appearance of local osteosarcoma recurrences in pediatric patients. Pediatr Radiol. 47(13):1800-8, 2017
                                                                                          9. Anderson ME: Update on survival in osteosarcoma. Orthop Clin North Am. 47(1):283-92, 2016
                                                                                          10. Fidler MM et al: Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study. Br J Cancer. 112(12):1857-65, 2015
                                                                                          11. Isakoff MS et al: Osteosarcoma: current treatment and a collaborative pathway to success. J Clin Oncol. 33(27):3029-35, 2015
                                                                                          12. Muheremu A et al: Positron emission tomography/computed tomography for bone tumors (Review). Oncol Lett. 9(2):522-6, 2015
                                                                                          13. Salah S et al: Factors predicting survival following complete surgical remission of pulmonary metastasis in osteosarcoma. Mol Clin Oncol. 3(1):157-62, 2015
                                                                                          14. Ferrari S et al: Nonmetastatic osteosarcoma of the extremity. Neoadjuvant chemotherapy with methotrexate, cisplatin, doxorubicin and ifosfamide. An Italian Sarcoma Group study (ISG/OS-Oss). Tumori. 100(6):612-9, 2014
                                                                                          15. Lee JS et al: Secondary malignant neoplasms among children, adolescents, and young adults with osteosarcoma. Cancer. 120(24):3987-93, 2014
                                                                                          16. Subhawong TK et al: Diffusion-weighted MR imaging for characterizing musculoskeletal lesions. Radiographics. 34(5):1163-77, 2014
                                                                                          17. Guo J et al: Dynamic contrast-enhanced magnetic resonance imaging as a prognostic factor in predicting event-free and overall survival in pediatric patients with osteosarcoma. Cancer. 118(15):3776-85, 2012
                                                                                          18. Kaste SC: Imaging pediatric bone sarcomas. Radiol Clin North Am. 49(4):749-65, vi-vii, 2011
                                                                                          19. Jawad MU et al: In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system. Clin Orthop Relat Res. 468(7):2000-2, 2010
                                                                                          20. Hayashida Y et al: Monitoring therapeutic responses of primary bone tumors by diffusion-weighted image: initial results. Eur Radiol. 16(12):2637-43, 2006
                                                                                          21. Bacci G et al: Prognostic significance of serum lactate dehydrogenase in osteosarcoma of the extremity: experience at Rizzoli on 1421 patients treated over the last 30 years. Tumori. 90(5):478-84, 2004
                                                                                          22. Kaste SC et al: Tumor size as a predictor of outcome in pediatric non-metastatic osteosarcoma of the extremity. Pediatr Blood Cancer. 43(7):723-8, 2004
                                                                                          23. Sajadi KR et al: The incidence and prognosis of osteosarcoma skip metastases. Clin Orthop Relat Res. (426):92-6, 2004