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Juxtacortical, High-Grade Osteosarcoma (Periosteal Osteosarcoma)

DEFINITION AND PATHOGENESIS

  • A relatively uncommon surface osteosarcoma with perhaps a slightly better prognosis than high grade intramedul-lary osteosarcoma

IMPORTANCE

Distinguishing these lesions from benign look-alikes is imperative (eg, periosteal chondroma)

  • Rare

CLINICAL FEATURES

  • Pain (33%), swelling (33%), or pain and swelling (33%), for 1-24 months

RADIOLOGIC FEATURES

  • Diaphyseal/metadiaphyseal
  • Most often occurs in adolescents
  • 85% about the knee
  • Perpendicular spiculations, "saucer-shaped" to fusiform, eccentric, juxtacortical mass
  • Bone scan with ? uptake

GROSS PATHOLOGY

  • Fusiform mass in the juxtacortical tissue with rounded margins
  • Bluish cartilage hue ? focal hemorrhage

HISTOLOGIC FEATURES

  • Chondrosarcomatous appearance

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

  • Parosteal chondrosarcoma
  • Parosteal osteosarcoma
  • Periostitis ossificans with a prominent cartilage component
  • Parosteal chondroma
  • Florid reactive periostitis ossificans

DISEASE COURSE AND TREATMENT

  • Metastatic potential related to histologic grade
  • Wide resection, chemotx

FIGURES

REFERENCES

Raymond AK: Surface osteosarcoma: Clin Orthop 270:140-8,1991.
Unni KK, Dahlin D, Beabout J: Periosteal osteosarcoma. Cancer 37:2466-75,1976.
Wold LE, Unni KK, Beabout J, Pritchard D: High grade surface osteosarcoma. Am J Surg Pathol 8:181-6,1984.

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