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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Written by Li Jie
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Does osteosarcoma hurt when pressed?

Osteosarcoma, also known as osteogenic sarcoma, is a primary malignant tumor of the bone. It ranks second in incidence among bone tumors and has a relatively high incidence and malignancy rate. It is more common in adolescents and occurs more frequently in males than in females. The earliest clinical symptoms of this disease include dull pain and persistent pain that worsens with activity, as well as nighttime pain, which is more pronounced than daytime pain. This is a very important characteristic, indicating that patients experience nighttime pain and rest pain. The affected area may develop a rapidly growing mass that changes significantly in size from month to month. If the tumor grows large, pressing on it can cause pain, but in the early stages when the tumor is not very large, the tenderness may not be very apparent, presenting only as localized spontaneous pain, which requires attention.

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Written by Na Hong Wei
Orthopedics
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What is osteosarcoma?

Osteosarcoma is a type of malignant tumor that occurs in the bones, generally classified as stage IIb. Common sites for osteosarcoma include the distal part of the bone, the proximal tibia, and the proximal humerus. It most commonly affects adolescents. Clinically, it primarily presents as persistent pain, including nighttime pain. Swelling and limited joint function typically occur around the common sites. Additionally, there are general symptoms associated with cachexia, such as malnutrition, anemia, mild or high fever, or weight loss. Fourthly, it is very prone to causing pathological fractures. Many osteosarcoma patients seek medical attention due to these fractures. Thus, osteosarcoma is a serious malignancy in the bones with a generally poor prognosis. Diagnosis and treatment of osteosarcoma are crucial; upon confirmation, timely treatment is necessary. The primary treatment approach is a combination therapy centered around surgery, typically involving preoperative chemotherapy, followed by surgical treatment and postoperative chemotherapy. Currently, the five-year survival rate for osteosarcoma has significantly improved, reaching approximately 70% to over 80%.

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Written by Na Hong Wei
Orthopedics
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Is osteosarcoma a cancer?

If we are to speak strictly, osteosarcoma is not cancer. This is because cancer typically refers to malignant tumors of epithelial tissue, whereas osteosarcoma, like all sarcomas, is a malignant tumor that occurs in connective or muscle tissue. Therefore, their origins are different: osteosarcoma is not cancer; it is a malignant tumor that occurs in bone tissue, commonly found in the distal femur, proximal tibia, and proximal humerus. So, strictly speaking, osteosarcoma is a sarcoma, a malignant tumor that occurs in bone tissue. It is not what one would typically refer to as cancer, which usually pertains to epithelial tissues, such as in cases of skin cancer or breast cancer. Osteosarcoma is therefore classified as a sarcoma, not as cancer.

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Orthopedics
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Can osteosarcoma occur on the knee?

Can osteosarcomas grow on the knee? In fact, the locations where osteosarcomas commonly appear are indeed near the knee. There are mainly three common sites: the most prevalent is the distal end of the femur, the lower part of the thigh bone. The second most common site is the proximal end of the tibia. The third is the proximal end of the humerus. Therefore, osteosarcomas usually do grow near the knee. What are the symptoms of an osteosarcoma? The symptoms of osteosarcoma include, first, localized pain, which is a constant pain that persists, worsens, and does not alleviate, often causing night pain, and many patients do not feel pain during the day, only at night. The second symptom is a localized lump, generally spindle-shaped, with an increased skin temperature over the surface, and even distended veins due to the tumor restricting nearby joint movement. The third symptom is the appearance of cachexia or wasting syndrome throughout the body. The fourth point is that the growth of the osteosarcoma leads to erosion of the bone and eventually pathologic fractures. Thus, the likelihood of osteosarcomas appearing near the knee is very high, and many patients typically come to the hospital because of painful lumps near the knee, and then, after examination, the diagnosis is confirmed.

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How long can osteosarcoma last?

Osteosarcoma, also known as osteogenic sarcoma, commonly occurs in adolescents, especially in children and teenagers under the age of 20. It is one of the most malignant tumors among bone tumors, with most patients dying within six months to a year. However, early detection and treatment can potentially extend survival. The survival period of osteosarcoma depends on the location of the tumor; the closer to the distal extremities, the longer the survival period after treatment; the closer to the trunk, even with treatment, the survival period is not very long.