Skip to main content
SpringerLink
Log in

A review of imaging of surface sarcomas of bone

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Surface lesions of bone are uncommon. Although their imaging features generally mirror those of their intramedullary counterparts, surface lesions may demonstrate distinct characteristics which along with their unusual location present a diagnostic challenge. Surface sarcomas are usually of a lower grade compared with intramedullary variants, leading to differences in management. Osteosarcoma arising from the cortical surface of the bone is termed juxtacortical or surface osteosarcoma and includes three distinct entities: parosteal, periosteal, and high-grade surface osteosarcoma. We also review the features intracortical osteosarcoma, which some authors include under the umbrella term surface osteosarcoma. These lesions exhibit biologic features distinct from those of conventional intramedullary osteosarcoma, which underlines the importance of accurate imaging diagnosis. Periosteal chondrosarcoma and periosteal Ewing sarcoma also have distinctive imaging appearances. The purpose of this article is to review surface sarcomas of bone with regard to their clinical and radiological features and to discuss the differential diagnosis for each condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25

Similar content being viewed by others

References

  1. Seeger LL, Yao L, Eckardt JJ. Surface lesions of bone. Radiology. 1998;206(1):17–33.

    CAS  PubMed  Google Scholar 

  2. Chaabane S, Bouaziz MC, Drissi C, Abid L, Ladeb MF. Periosteal Chondrosarcoma. Am J Roentgenol. 2009;192(1):W1–6.

    Google Scholar 

  3. Shapeero LG, Vanel D, Sundaram M, Ackerman LV, Wuisman P, Bauer TW, et al. Periosteal Ewing sarcoma. Radiology. 1994;191(3):825–31.

    CAS  PubMed  Google Scholar 

  4. Murphey MD, Robbin MR, McRae GA, Flemming DJ, Temple HT, Kransdorf MJ. The many faces of osteosarcoma. Radiographics. 1997 Sep-Oct;17(5):1205–31.

    CAS  PubMed  Google Scholar 

  5. Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004. Cancer. 2009;115(7):1531–43.

    PubMed  PubMed Central  Google Scholar 

  6. Spina V, Montanari N, Romagnoli R. Malignant tumors of the osteogenic matrix. Eur J Radiol. 1998;27:S98–S109.

    PubMed  Google Scholar 

  7. Klein MJ, Siegal GP. Osteosarcoma: anatomic and histologic variants. Am J Clin Pathol. 2006 Apr;125(4):555–81.

    PubMed  Google Scholar 

  8. Dwek JR. The periosteum: what is it, where is it, and what mimics it in its absence? Skelet Radiol. 2010 Apr;39(4):319–23.

    Google Scholar 

  9. Kundu ZS. Classification, imaging, biopsy and staging of osteosarcoma. Indian J Orthop. 2014;48(3):238–46.

    PubMed  PubMed Central  Google Scholar 

  10. Yarmish G, Klein MJ, Landa J, Lefkowitz RA, Hwang S. Imaging characteristics of primary osteosarcoma: nonconventional subtypes. Radiographics. 2010 Oct;30(6):1653–72.

    PubMed  Google Scholar 

  11. Nouri H, Ben Maitigue M, Abid L, Nouri N, Abdelkader A, Bouaziz M, et al. Surface osteosarcoma: clinical features and therapeutic implications. J Bone Oncol. 2015 Dec;4(4):115–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Raymond AK. Surface osteosarcoma. Clin Orthop Relat Res. 1991 Sep;270:140–8.

    Google Scholar 

  13. WHO Classification of Tumours Editorial Board. Soft Tissue and Bone Tumours. Lyon (France). International Agency for Research on Cancer; 2020. (WHO Classification of Tumours Series. 5th Ed.; Volume 3). 2020.

  14. Suresh S, Saifuddin A. Radiological appearances of appendicular osteosarcoma: a comprehensive pictorial review. Clin Radiol. 2007;62(4):314–23.

    CAS  PubMed  Google Scholar 

  15. Staals EL, Bacchini P, Bertoni F. High-grade surface osteosarcoma: a review of 25 cases from the Rizzoli institute. Cancer. 2008;112(7):1592–9.

    PubMed  Google Scholar 

  16. Unni KK, Dahlin DC, Beabout JW. Periosteal osteogenic sarcoma. Cancer. 1976;37(5):2476–85.

    CAS  PubMed  Google Scholar 

  17. Okada K, Frassica FJ, Sim FH, Beabout JW, Bond JR, Unni KK. Parosteal osteosarcoma. A clinicopathological study. J Bone Joint Surg Am. 1994;76(3):366–78.

    CAS  PubMed  Google Scholar 

  18. Kenan S, Abdelwahab IF, Klein MJ, Hermann G, Lewis MM. Lesions of juxtacortical origin (surface lesions of bone). Skelet Radiol. 1993;22(5):337–57.

    CAS  Google Scholar 

  19. Kumar VS, Barwar N, Khan SA. Surface osteosarcomas: diagnosis, treatment and outcome. Indian J Orthop. 2014;48(3):255–61.

    PubMed  PubMed Central  Google Scholar 

  20. Murphey MD, Jelinek JS, Temple HT, Flemming DJ, Gannon FH. Imaging of periosteal osteosarcoma: radiologic-pathologic comparison. Radiology. 2004;233(1):129–38.

    PubMed  Google Scholar 

  21. Rougraff BT. Variants of osteosarcoma. Curr Opin Orthop. 1999;10(6):485–90.

    Google Scholar 

  22. Dorfman HD, Czerniak B. Bone cancers. (0008-543X (Print)).

  23. Kim M-J, Cho K-J, Ayala AG, Ro JY. Chondrosarcoma: with updates on molecular genetics. Sarcoma. 2011;2011:405437.

    PubMed  PubMed Central  Google Scholar 

  24. Robinson P, White LM, Sundaram M, Kandel R, Wunder J, McDonald DJ, et al. Periosteal chondroid tumors: radiologic evaluation with pathologic correlation. Am J Roentgenol. 2001;177(5):1183–8.

    CAS  Google Scholar 

  25. Murphey MD, Senchak LT, Mambalam PK, Logie CI, Klassen-Fischer MK, Kransdorf MJ. From the radiologic pathology archives: Ewing sarcoma family of tumors: radiologic-pathologic correlation. RadioGraphics. 2013;33(3):803–31.

    PubMed  Google Scholar 

  26. Hang JF, Chen PC. Parosteal osteosarcoma. Arch Pathol Lab Med. 2014;138(5):694–9.

    PubMed  Google Scholar 

  27. Okada K, Unni KK, Swee RG, Sim FH. High grade surface osteosarcoma: a clinicopathologic study of 46 cases. Cancer. 1999;85(5):1044–54.

    CAS  PubMed  Google Scholar 

  28. Bertoni F, Bacchini P, Staals EL, Davidovitz P. Dedifferentiated parosteal osteosarcoma: the experience of the Rizzoli Institute. Cancer. 2005;103(11):2373–82.

    PubMed  Google Scholar 

  29. Lin HY, Hondar Wu HT, Wu PK, Wu CL, Chih-Hsueh Chen P, Chen WM, et al. Can imaging distinguish between low-grade and dedifferentiated parosteal osteosarcoma? J Chin Med Assoc. 2018;81(10):912–9.

    PubMed  Google Scholar 

  30. Encinas-Ullan CA, Ortiz-Cruz EJ, Barrientos-Ruiz I, Valencia-Mora M, Gonzalez-Lopez JM. Parosteal osteosarcomas: unusual findings. Rev Esp Cir Ortop Traumatol. 2012;56(4):281–5.

    CAS  PubMed  Google Scholar 

  31. Müller-Miny H, Erlemann R, Wuisman P, Bosse A, Peters PE. The x-ray morphology of parosteal osteosarcoma (POS). RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 1991;155(2):165–70.

    PubMed  Google Scholar 

  32. Jelinek JS, Murphey MD, Kransdorf MJ, Shmookler BM, Malawer MM, Hur RC. Parosteal osteosarcoma: value of MR imaging and CT in the prediction of histologic grade. Radiology. 1996;201(3):837–42.

    CAS  PubMed  Google Scholar 

  33. Kaste SC, Fuller CE, Saharia A, Neel MD, Rao BN, Daw NC. Pediatric surface osteosarcoma: clinical, pathologic, and radiologic features. Pediatr Blood Cancer. 2006;47(2):152–62.

    PubMed  Google Scholar 

  34. Han I, Oh JH, Na YG, Moon KC, Kim HS. Clinical outcome of parosteal osteosarcoma. J Surg Oncol. 2008;97(2):146–9.

    PubMed  Google Scholar 

  35. Laitinen M, Parry M, Albergo JI, Jeys L, Abudu A, Carter S, et al. The prognostic and therapeutic factors which influence the oncological outcome of parosteal osteosarcoma. Bone Joint J. 2015;97-B(12):1698–703.

    CAS  PubMed  Google Scholar 

  36. Bast RC. Holland-frei cancer medicine. Hoboken: John Wiley & Sons; 2017.

    Google Scholar 

  37. Kumar R, Moser RP Jr, Madewell JE, Edeiken J. Parosteal osteogenic sarcoma arising in cranial bones: clinical and radiologic features in eight patients. AJR Am J Roentgenol. 1990;155(1):113–7.

    CAS  PubMed  Google Scholar 

  38. Lin J, Yao L, Mirra JM, Bahk WJ. Osteochondromalike parosteal osteosarcoma: a report of six cases of a new entity. AJR Am J Roentgenol. 1998;170(6):1571–7.

    CAS  PubMed  Google Scholar 

  39. Bertoni F, Unni KK, Beabout JW, Sim FH. Parosteal osteoma of bones other than of the skull and face. Cancer. 1995;75(10):2466–73.

    CAS  PubMed  Google Scholar 

  40. Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ. From the archives of the AFIP: benign musculoskeletal lipomatous lesions. RadioGraphics. 2004;24(5):1433–66.

    PubMed  Google Scholar 

  41. Chan CM, Lindsay AD, Spiguel ARV, Gibbs CP Jr, Scarborough MT. Periosteal osteosarcoma: a single-institutional study of factors related to oncologic outcomes. Sarcoma. 2018;2018:8631237.

    PubMed  PubMed Central  Google Scholar 

  42. Liu X-W, Zi Y, Xiang L-B, Han T-Y. Periosteal osteosarcoma: a review of clinical evidence. Int J Clin Exp Med. 2015;8(1):37.

    PubMed  PubMed Central  Google Scholar 

  43. Hoshi M, Matsumoto S, Manabe J, Tanizawa T, Shigemitsu T, Takeuchi K, et al. Report of four cases with high-grade surface osteosarcoma. Jpn J Clin Oncol. 2006;36(3):180–4.

    PubMed  Google Scholar 

  44. Vanel D, Picci P, De Paolis M, Mercuri M. Radiological study of 12 high-grade surface osteosarcomas. Skelet Radiol. 2001;30(12):667–71.

    CAS  Google Scholar 

  45. Okada K, Kubota H, Ebina T, Kobayashi T, Abe E, Sato K. High-grade surface osteosarcoma of the humerus. Skelet Radiol. 1995;24(7):531–4.

    CAS  Google Scholar 

  46. Schajowicz F, McGuire M, Araujo ES, Muscolo D, Gitelis S. Osteosarcomas arising on the surfaces of long bones. JBJS. 1988;70(4):555–64.

    CAS  Google Scholar 

  47. Yang SH, Wu CT, Wang CJ, Kuo MS, Yang RS. Intracortical osteosarcoma: report of a case. J Formos Med Assoc. 2000;99(9):721–5.

    CAS  PubMed  Google Scholar 

  48. Jaffe HL. Intracortical osteogenic sarcoma. Bull Hosp Joint Dis. 1960;21:189–97.

    CAS  PubMed  Google Scholar 

  49. Vanhoenacker F, De Beuckeleer LH, De Schepper AM. Intracortical osteosarcoma: is MRI useful? Rofo. 2001;173(10):959–60.

    CAS  PubMed  Google Scholar 

  50. Griffith J, Kumta S, Chow L, Chung L, Metreweli C. Intracortical osteosarcoma. Skelet Radiol. 1998;27:228–32.

    CAS  Google Scholar 

  51. Rosenberg ZS, Lev S, Schmahmann S, Steiner GC, Beltran J, Present D. Osteosarcoma: subtle, rare, and misleading plain film features. AJR Am J Roentgenol. 1995;165(5):1209–14.

    CAS  PubMed  Google Scholar 

  52. Hermann G, Klein MJ, Springfield D, Abdelwahab IF, Dan SJ. Intracortical osteosarcoma; two-year delay in diagnosis. Skelet Radiol. 2002;31(10):592–6.

    CAS  Google Scholar 

  53. Mirra JM, Dodd L, Johnston W, Frost DB, Barton D. Case report 700: primary intracortical osteosarcoma of femur, sclerosing variant, grade 1 to 2 anaplasia. Skelet Radiol. 1991;20(8):613–6.

    CAS  Google Scholar 

  54. Kyriakos M. Intracortical osteosarcoma. Cancer. 1980;46(11):2525–33.

    CAS  PubMed  Google Scholar 

  55. Picci P, Gherlinzoni F, Guerra A. Intracortical osteosarcoma: rare entity or early manifestation of classical osteosarcoma? Skelet Radiol. 1983;9(4):255–8.

    CAS  Google Scholar 

  56. Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH. From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. RadioGraphics. 2003;23(5):1245–78.

    PubMed  Google Scholar 

  57. Bertoni F, Boriani S, Laus M, Campanacci M. Periosteal chondrosarcoma and periosteal osteosarcoma. Two distinct entities. J Bone Joint Surg Br. 1982;64(3):370–6.

    CAS  PubMed  Google Scholar 

  58. Díaz CM, Fernández RS, García ER, Armendariz PF, Angulo CD. Surface primary bone tumors: systematic approach and differential diagnosis. Skelet Radiol. 2015;44(9):1235–52.

    Google Scholar 

  59. Liu C, Xi Y, Li M, Jiao Q, Zhang H, Yang Q, et al. Dedifferentiated chondrosarcoma: radiological features, prognostic factors and survival statistics in 23 patients. PLoS One. 2017;12(3):e0173665.

    PubMed  PubMed Central  Google Scholar 

  60. Kumta SM, Griffith JF, Chow LTC, Leung PC. Primary juxtacortical chondrosarcoma dedifferentiating after 20 years. Skelet Radiol. 1998;27(10):569–73.

    CAS  Google Scholar 

  61. Bator SM, Bauer TW, Marks KE, Norris DG. Periosteal Ewing’s sarcoma. Cancer. 1986;58(8):1781–4.

    CAS  PubMed  Google Scholar 

  62. Hakozaki M, Hojo H, Tajino T, Yamada H, Kikuta A, Ito M, et al. Periosteal Ewing sarcoma family of tumors of the femur confirmed by molecular detection of EWS-FLI1 fusion gene transcripts: a case report and review of the literature. J Pediatr Hematol Oncol. 2007;29(8):561–5.

    PubMed  Google Scholar 

  63. Sherman RS, Soong KY. Ewing's sarcoma: its roentgen classification and diagnosis. Radiology. 1956;66(4):529–39.

    CAS  PubMed  Google Scholar 

  64. Kollender Y, Shabat S, Nirkin A, Issakov J, Flusser G, Merimsky O, et al. Periosteal Ewing’s sarcoma: report of two new cases and review of the literature. Sarcoma. 1999;3(2):85–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Hatori M, Okada K, Nishida J, Kokubun S. Periosteal Ewing’s sarcoma: radiological imaging and histological features. Arch Orthop Trauma Surg. 2001;121(10):594–7.

    CAS  PubMed  Google Scholar 

  66. Aymoré IL, Meohas W, de Almeida ALB, Proebstner D. Case report: Periosteal Ewing’s sarcoma: case report and literature review. Clin Orthop Relat Res. 2005;434:265–72.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada

    Kelly Harper, Paul Sathiadoss & Adnan Sheikh

  2. Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Asif Saifuddin

Authors
  1. Kelly Harper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul Sathiadoss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asif Saifuddin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adnan Sheikh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Sathiadoss.

Ethics declarations

Conflict of interest

Adnan Sheikh is on a speaker’s bureau for Siemens AG. The rest of the authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harper, K., Sathiadoss, P., Saifuddin, A. et al. A review of imaging of surface sarcomas of bone. Skeletal Radiol 50, 9–28 (2021). https://doi.org/10.1007/s00256-020-03546-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03546-1

Keywords

Search

Navigation