A 7-year-old male underwent preoperative chemotherapy and resection of a right proximal tibia osteosarcoma with prosthesis placement. He presents for ongoing right lower extremity reconstruction. Preoperative X-ray of the right lower leg shows the proximal tibial malignant osseous neoplasm involving the metadiaphysis. Areas of increased attenuation suggest osteoid formation and cortical destruction as well as aggressive periosteal new bone deposition. Localized soft tissue mass anterior to the tibial epiphysis and tubercle is present with Codman triangle form elevation of periosteum, pathognomonic of osteosarcoma.
Pre-operative right lower extremity MRI with and without contrast using multiplanar T1, fat suppressed T2, STIR and post-contrast fat suppressed images shows a 14.1 x 4.7 x 5.6 cm malignant primary osseous neoplasm of the proximal tibia with involvement of the epiphysis, metaphysis, and proximal diaphysis extending to the cortex anteriorly, as well as formation of osteoid and aggressive periosteal reaction compatible with osteogenic sarcoma. No pathologic fractures are noted.
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