Skeletal Radiology

, Volume 38, Issue 7, pp 685–690 | Cite as

Parosteal osteosarcoma dedifferentiating into telangiectatic osteosarcoma: importance of lytic changes and fluid cavities at imaging

  • M. Azura
  • D. VanelEmail author
  • M. Alberghini
  • P. Picci
  • E. Staals
  • M. Mercuri
Scientific Article



This study was performed to assess the imaging findings in cases of parosteal osteosarcoma dedifferentiated into telangiectatic osteosarcoma. Parosteal osteosarcoma is a low-grade well-differentiated malignant tumor. Dedifferentiation into a more aggressive lesion is frequent and usually visible on imaging as a central lytic area in a sclerotic mass. Only one case of differentiation into a telangiectatic osteosarcoma has been reported. As it has practical consequences, with a need for aggressive chemotherapy, we looked for this rather typical imaging pattern.

Materials and methods

Review of 199 cases of surface osteosarcomas (including 86 parosteal, of which 23 were dedifferentiated) revealed lesions suggesting a possible telangiectatic osteosarcoma on imaging examinations in five cases (cavities with fluid). Histology confirmed three cases (the two other only had hematoma inside a dedifferentiated tumor). There were three males, aged 24, 28, and 32. They had radiographs and CT, and two an MR examination.


Lesions involved the distal femur, proximal tibia, and proximal humerus. The parosteal osteosarcoma was a sclerotic, regular mass, attached to the cortex. A purely lytic mass, partially composed of fluid cavities was easily detected on CT and MR. It involved the medullary cavity twice, and remained outside the bone once. Histology confirmed the two components in each case. Two patients died of pulmonary metastases and one is alive.


Knowledge of this highly suggestive pattern should help guide the initial biopsy to diagnose the two components of the tumor, and guide aggressive treatment.


Telangiectatic osteosarcoma Parosteal osteosarcoma Fluid–fluid levels CT MRI 


  1. 1.
    Wines A, Bonar F, Lam P, McCarthy S, Stalley P. Telangiectatic dedifferentiation of a parosteal osteosarcoma. Skeletal Radiol 2000; 29: 597–600.PubMedCrossRefGoogle Scholar
  2. 2.
    Geschickter CF, Copeland MM. Parosteal osteoma of bone. A new entity. Ann Surg 1951; 133: 790–807.PubMedCrossRefGoogle Scholar
  3. 3.
    Campanacci M. Bone and soft tissue tumours, 2nd ed. New York: Springer, 1999. 491–548.Google Scholar
  4. 4.
    Mirra JM. Bone tumours: clinical, radiologic and pathologic correlations. Philadelphia: Lea and Febiger, 1989.Google Scholar
  5. 5.
    Fechner RE, Mills SE. Tumours of the bones and joints. Washington DC: Armed Forces Institute of Pathology, 1993.Google Scholar
  6. 6.
    Christopher DM, Fletcher K, Unni K, Martens F. Pathology and genetics of tumours of soft tissue and bone. World Health Organization Classification of Tumours: WHO 2002. 279-281.Google Scholar
  7. 7.
    Okada K, Frassica FJ, Sim FH, Beabout JW, Bond JR, Unni KK. Parosteal osteosarcoma: a clinicopathological study. J Bone Joint Surg Am 1994; 76: 366–378.PubMedGoogle Scholar
  8. 8.
    Paget J. Lectures on surgical pathology. Philadelphia: Lindsay and Blackiston, 1854.Google Scholar
  9. 9.
    Mervak TR, Unni KK, Pitchard DJ, Mc Leod RA. Telangiectatic osteosarcoma. Clin Orthop 1991; 270: 135–139.PubMedGoogle Scholar
  10. 10.
    Bertoni F, Bacchini P, Staals EL, Davidovitz P. Dedifferentiated parosteal osteosarcoma: the experience of the Rizzoli Institute. Cancer 2005; 103(11): 2373–2382.PubMedCrossRefGoogle Scholar
  11. 11.
    Unni KK, Dahlin DC, Beabout JW, Ivins JC. Parosteal osteogenic sarcoma. Cancer 1976; 37: 2466–2475.PubMedCrossRefGoogle Scholar
  12. 12.
    Bertoni F, Present D, Hudson T, Enneking WF. The meaning of radiolucencies in parosteal osteosarcoma. J Bone Joint Surg 1985; 67(6): 901–910.PubMedGoogle Scholar
  13. 13.
    Campanacci M, Picci P, Gherlinzoni F, Guerra A, Bertoni F, Neff JR. Parosteal osteosarcoma. J bone Joint Surg Br 1984; 66: 313–321.PubMedGoogle Scholar
  14. 14.
    Sheth DS, Yasko AW, Raymond AK, et al. Conventional and dedifferentiated parosteal osteosarcoma: diagnosis, treatment and outcome. Cancer 1996; 78: 2136–2145.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2009

Authors and Affiliations

  • M. Azura
    • 1
    • 2
  • D. Vanel
    • 3
    • 5
    Email author
  • M. Alberghini
    • 4
  • P. Picci
    • 1
  • E. Staals
    • 1
  • M. Mercuri
    • 1
  1. 1.Musculoskeletal Oncological Surgery DepartmentIstituto Ortopedico RizzoliBolognaItaly
  2. 2.Department of Orthopaedic SurgeryUniversity of MalayaKuala LumpurMalaysia
  3. 3.Radiology, Istituto Ortopedico RizzoliBolognaItaly
  4. 4.Pathology, Istituto Ortopedico RizzoliBolognaItaly
  5. 5.Anatomia PatologicaIstituti RizzoliBolognaItaly

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