osteosarcoma X-ray presentation

Written by Li Xin
Pediatric Orthopedics
Updated on January 28, 2025
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The variations in the X-ray appearance of osteosarcoma are quite large, but the basic characteristics are a mix of osteolytic destruction and pure bony changes. In most cases, besides the mixed changes, there is also destruction of the bone cortex and invasion of soft tissues, with visible periosteal reaction. The epiphysis has a certain blocking effect on the tumor, hence it rarely crosses the epiphyseal line. On the X-ray, changes indicative of skip metastasis can be seen, along with typical Codman's triangle or sunburst patterns. Beneath the periosteum, there are fine, needle-like sunburst radiating changes, which are fairly typical radiographic changes of osteosarcoma and are generally used to diagnose the condition.

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Osteosarcoma etiology

Currently, in clinical practice, the pathogenesis of osteosarcoma is not fully understood. However, it may be related to genetics, exposure to radioactive materials, and viral infections. It can also be secondary to other deformative osteitis, fibrous dysplasia, and some benign tumors transforming into malignant bone tumors. Osteosarcoma primarily occurs in the metaphysis of long bones. The tumor spreads along the marrow cavity, extending towards both the metaphysis of the long bones and the diaphysis of the bones. Once the tumor breaks through the bone shaft, it rapidly destroys the cortical bone, spreads under the periosteum, and invades the surrounding soft tissues outside the eardrum, damaging the surrounding muscles and soft tissues.

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Why is there a cough in osteosarcoma?

Osteosarcoma ranks second in the incidence of malignant tumors in the whole body's bones; its incidence is relatively high. It generally occurs in the long tubular bones, shafts, or epiphyseal areas of the limbs. Since the most common organ metastasis of osteosarcoma is to the lungs, if a patient with osteosarcoma develops a cough, it should be taken seriously, and it's recommended that the patient undergo a targeted examination such as a chest X-ray or a CT scan of the lungs to check for lung metastasis and any lesions on the lungs. However, there is no need to panic prematurely, as osteosarcoma patients might cough due to upper respiratory infections or lung infections, which doesn't necessarily indicate lung metastasis. Therefore, once a patient with osteosarcoma develops a cough, a targeted examination should suffice.

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Written by Na Hong Wei
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Osteosarcoma mainly metastasizes through

The main metastatic pathways of osteosarcoma are generally divided into three types. The first is hematogenous spread, which refers to the dispersal of tumor cells throughout the body via the bloodstream, typically settling in areas with slower blood flow which facilitates the deposition of these cells leading to local changes. The second is direct implantation, which involves tumor cells directly establishing themselves in the vicinity of the tumor's common sites, eventually leading to local metastasis. The third type is lymphatic spread, where tumor cells migrate through the lymphatic system, spreading along lymphatic vessels or pathways. Therefore, the main metastatic pathways of osteosarcoma are these three types. The primary sites of metastasis for osteosarcoma are mainly the lungs, but metastases can also occur in the brain or through other mechanisms.

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Does osteosarcoma require amputation?

Do osteosarcomas require amputation? In the past, the likelihood of amputation for treating osteosarcoma was very high. However, currently, the rate of amputation is very low, and the limb-salvage rate is very high. This is due to a new chemotherapy protocol in medical practice, which involves initial chemotherapy followed by surgery, and then continued chemotherapy post-operatively. The limb-salvage rate with this treatment plan can reach about 75% to 80%. Therefore, currently, most osteosarcoma patients do not require amputation. Unlike the past, where amputation rates were very high, today's medical approach is very advanced, generally resulting in a very high rate of limb preservation for osteosarcoma patients.

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Characteristics of Osteosarcoma

Osteosarcoma is a malignant tumor of the bone that primarily occurs in adolescents and young adults, commonly found at the metaphyseal ends of long bones. For example, it may occur at the distal end of the tibia, the distal end of the femur, or the metaphyseal end of the humerus. Clinically, the main symptom is pain, which is persistent and more noticeable at night, accompanied by a local mass, limited movement, increased local skin temperature, distended veins, and general symptoms such as weight loss and even cachexia. Some patients may experience pathological fractures. Often, there are no symptoms in the early stages, and by the time it is detected, it is usually in an intermediate or advanced stage. Radiographic examination typically shows a Codman's triangle or sunburst pattern. Early detection and treatment are crucial. The usual treatment choice is surgical, such as deactivation and reimplantation, or limb-salvage surgery with prosthetic implantation. Additionally, amputation followed by extensive chemotherapy is another option. With recent advances in chemotherapy, there has been significant improvement in life extension.