A 19-year-old white man presented with left knee pain and radiographs (Fig. 1). Open biopsy revealed high-grade osteogenic sarcoma. Bone scan showed another lesion involving the pedicle and transverse process of L1 (Fig. 2). CT and MRI were suggestive of osteosarcoma (Fig. 3). Biopsy revealed multicentric osteosarcoma.
After preoperative multidrug chemotherapy, the patient underwent resection of his distal femur with replacement with a massive prosthesis (Fig. 4). Tumor necrosis was found to be 99%.
He underwent 2 more cycles of chemotherapy followed by en bloc resection of his L1 tumour (Fig. 5). Tumor necrosis was found to be 100%. Anterior and posterior instrumentation was successful (Fig. 6).
The most recent follow-up, at 2 years, demonstrates excellent outcome with full extension of his left knee and flexion to 105°. He has very minimal functional limitation.
Synchronous multifocal osteosarcoma is most often thought to represent the phenomenon of bony metastasis, but in some patients, aggressive management leads to cure.
Footnotes
Submissions to Surgical Images, musculoskeletal section, should be sent to the section editor: Dr. Edward J. Harvey, McGill University Health Centre, Department of Orthopaedic Surgery, Montréal General Hospital, Rm. B5.159.5, 1650 Cedar Ave., Montréal QC H3G 1A4; edward.harvey{at}muhc.mcgill.ca
Competing interests: None declared.