Tumor | Usual age at diagnosis | Common primary sites | Radiographic appearance | Distinctive features | Clinical course |
Osteosarcoma | Second and third decade | Around knee joint and shoulder | Variable, depending on degree of mineralization of osteoid | Tumor osteoid present; variable degrees of osteo-blastic, chondro-blastic, and fibroblastic differentiation | Early dissemination to lungs ± skeleton |
Conventional | |||||
Osteoblastic | |||||
Chondroblastic | |||||
Fibroblastic | |||||
Telangiectatic | Second and third decade | Similar to conventional osteosarcoma | Predominantly lytic lesion with little or no sclerosis | Cystic, cavity-like tumor; blood-filled spaces in tumor | Similar to conventional osteosarcoma |
Small cell | Second and third decade | Similar to conventional osteosarcoma | May be predominantly lytic | May be confused with Ewing's sarcoma | Similar to conventional osteosarcoma; radioresponsive |
Multifocal | - | Synchronous involvement of multiple bones | Multiple skeletal sites showing densely sclerotic lesions | ? Multiple primary tumors versus metastatic primary tumor | Uniformly fatal |
Parosteal (juxtacortical osteosarcoma) | Third decade or older | Posterior aspect of distal femur | Arises from cortex; encircles involved bone; pronounced ossification | Low-grade tumor with characteristic radiograph and pathology | Indolent clinical course with low propensity for metastases |
Periosteal (juxtacortical chondro-sarcoma) | First-seventh decade | Tibia and femur | Tumor located superficially in cortex | Tumor limited to periphery of cortex | Intermediate prognosis |
Fibrosarcoma | Second-sixth decade | Similar to osteosarcoma | Usually lytic | Spindle cells and collagen but no osteoid | Similar to osteosarcoma |
Chondrosarcoma | Third-seventh decade; usually older adults | Most in trunk (especially pelvis) and proximal limbs | Bone destruction and fluffy calcification | Prolonged history of symptoms; proliferating tissue is fully developed cartilage without tumor osteoid | Metastases rare but may appear many years later |
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