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Imaging Findings in Pseudocystic Osteosarcoma

¹ Department of Radiology, St. Louis University Health Sciences Center, 3635 Vista at Grand, St. Louis, MO 63110-0250.
² Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO 63110.
³ Department of Surgical Pathology, Washington University School of Medicine, St. Louis, MO 63110.
⁴ Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110.
⁵ Department of Orthopedic Surgery, St. Louis University Health Sciences Center, St. Louis, MO 63110-0250.

OBJECTIVE. Our purpose was to describe four female patients with osteosarcoma whose clinical and imaging findings primarily suggested either simple or aneurysmal bone cyst. All lesions were osteolytic, intracompartmental, and expanded bone without periosteal reaction. None of the patients presented during the peak age incidence for osteosarcoma. From imaging to histologic diagnosis, the discovery of osteosarcoma ranged from 1 week to 3 years.

CONCLUSION. Atypical osteosarcoma may rarely mimic simple or aneurysmal bone cyst radiologically and may show a nonmalignant rate of growth. It may be more frequently encountered in females and may not present during the peak age incidence for osteosarcoma. Microscopically, the tumors were not cystic, necrotic, or telangiectatic but were conventional osteosarcoma and osteoclast-rich osteosarcoma.

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