1. Volume 3
Osteosarcoma Variants
Hemorrhagic osteosarcoma------------Case 110 & 499-503
Parosteal osteosarcoma-----------------Case111 & 504-510
Periosteal osteosarcoma----------------Case 112 & 511-517
Pagetic sarcoma-------------------------Case 113 & 518-528
Low grade intramedullary OGS------Case 114 & 528.1-530
Radiation induced OGS---------------Case 115 & 531-537
Multicentric osteosarcoma------------Case 116 & 538-542
Soft tissue osteosarcoma--------------Case 118 & 543-545
Intracortical osteosarcoma------------Case 119 & 546-547

2. Osteogenic
Sarcoma
Variants

3. Hemorrhagic
Osteogenic
Sarcoma

4. Hemorrhagic (Telangiectatic) Osteosarcoma
The hemorrhagic (OGS), an extremely lytic and hemorrhagic
variant of the osteosarcoma, presents in the same age group and
location as a classic osteosarcoma but has a radiographic
appearance almost identical to that of an aggressive aneurysmal
bone cyst, making for a very difficult differential consideration
for the radiologist. At the time of biopsy the tumor is very
hemorrhagic and has the gross appearance of an aneurysmal
bone cyst. Even microscopically, many areas of the hemorrhagic
OGS will have the appearance of an aneurysmal bone cyst with
only an occasional mitotic figure. For this reason, it is very
important for the surgeon who performs the biopsy to obtain
an adequate specimen with good sampling by means of an open
biopsy as apposed to a simple needle biopsy. The microscopic
features of the hemorrhagic OGS are a large number of benign-
appearing giant cells and thus the terminology “giant cell rich”

5. osteosarcoma that is used by many pathologists. There is very
little evidence of osteoblastic acitivity in the hemorrhagic OGS
and, because it is so lytic in character, it frequently presents with
a pathologic fracture early in the course of the disease and with that
come potential problems for the treating orthopedic surgeon who
must deal with the major contamination that occurs during the
fracture. Because of these possible complications, one might consider
an early limb salvage procedure before the fracture occurs.
It was once felt that the prognosis for the hemorrhagic OGS
was worse than that of the classic OGS because of its lytic dest-
uctive nature. However, since the advent of systemic chemotherapy,
the prognosis for survival is no different than that of a classic OGS.

6. CLASSIC
Case #110
23 year male
hemorrhagic OGS
proximal humerus
Aneurysmal lesion

7. hemorrhagic
tumor
Coronal T-1 MRI

8. Coronal T-1 MRI tumor
thru path fracture

9. Resected tumor cut in path lab

10. Photomic showing giant cells and malignant cells

11. osteoid
blood
Photomic showing hemorrhagic response

12. Neer
allograft
Post op x-ray with
alloprosthetic
reconstruction

13. 18 year followup x-rays

14. Case #499
15 year male
hemorrhagic OGS
distal femur

15. Lateral view

16. Bone scan

17. tumor
Sagittal T-2 MRI

18. hemorrhagic
tumor
Coronal T-2 MRI

19. tumor
Axial T- 2 MRI

20. blood
Photomic

21. osseo-
integration
3 yrs post op Compress
total knee reconstruction
CPS

22. Case #499.1 Hemorrhagic OGS
22 year male with a 3 month history of right knee pain

23. Cor T-1 PD FS Gad

24. Sag
PD

25. Axial PD FS Gad

26. Resection 16 cm distal femur and Compress recon

27. PO x-ray

28. Case #500
19 year male
hemorrhage OGS
proximal femur
Looks like ABC

29. Lateral view

30. Initial biopsy reveals aneurysmal bone cyst

31. 6 weeks later
shows lysis of
outer shell
Repeat biopsy
reveals
hemorrhagic OGS

32. femoral
head
tumor
Hip disarticulation specimen

33. 2nd biopsy Photomic

34. Case #501
6 year female
path fracture thru
unicameral bone cyst

35. cystic
lesion
Lateral view

36. 7 weeks after cyst
steroid injection

37. 1 month later and
progressive lytic
destruction

38. Biopsy here shows hemorrhagic OGS

39. Case #501.1 Telangiectatic OGS
19 year old male with
acute onset of pain 2 wks
ago in right hip

40. PO 1 mo
2 mo 3 mo

41. Cor T-1 T-2

42. Axial T-1 T-2
Gad

43. Sag T-2 Gad

44. Case #502
4 year male
cystic
looks like
lesion
unicameral bone cyst

45. Progressive lysis
after steroid injection

46. 2 months later
with progressive
lysis and looking
malignant

47. Biopsy reveals hemorrhagic OGS

48. Clinical appearance before shoulder disarticulation

49. Case #503
17 year female
hemorrhagic OGS
C-3

50. AP view

51. CT scan

52. Photomic

53. 6 years later with
spontaneous fusion
and no tumor

54. Parosteal
Ostogenic
Sarcoma

55. Parosteal Osteosarcoma
The parosteal (OGS) is a low grade variant arising from the surface
of a long bone that presents as an exophytic mass with dense fibro-
osseous tissue. It carries an excellent five year survival prognosis
of 85% and accounts for about 4% of all osteosarcomas. This
tumor has very little, if any, medullary involvement which clearly
separates it from the classic OGS. It is seen more commonly in
females than males and is found in a slightly older age group
than the classic OGS. By far the most common location for this
tumor is in the posterior aspect of the distal femur where it is
frequently presents with minimal symptoms of pain but with a
palpable tumor mass that might have been present many years
before medical advise was sought. Histologically, this tumor has a
very low mitotic index and in many cases can be confused with
a normal healing fracture callous with occasional areas of cartilage
being seen. Because this tumor is extremely low grade, it is not

56. responsive to adjuvant therapy such as chemotherapy or
radiation therapy. The treatment consists of a wide surgical
resection that must have safe margins, otherwise the recurrence
rate will be quite high. Recurrence can occur 10 to 15 years after
the surgery. In many cases the lesion can be resected without
sacrificing the adjacent joint, but in larger lesions the best
approach is a total joint replacement similar to that used for the
classic OGS.

57. CLASSIC
Case #111
32 year male
parosteal OGS
distal femur

58. AP view

59. Bone scan

60. Sagittal T-1 MRI

61. tumor
Sagittal STIR MRI

62. Axial T-1 MRI

63. tumor
Axial STIR MRI

64. Photomic

65. Higher power

66. Case #504
18 year male
parosteal OGS
distal femur

67. tumor
AP view

68. Bone scan

69. tumor
Axial T-2 MRI

70. tumor
Sagittal T-2 MRI

71. tumor
Macro section

72. Photomic

73. osseointegration
Compress total knee reconstruction 2 years later

74. 10 years later with
recurrence as a high
grade dedifferentiated
parosteal OGS
tumor

75. Another view
tumor

76. Photomic of recurrence

77. Close up of
osseointegration of
Compress implant

78. Case #505
32 year male
parosteal OGS tumor
proximal humerus

79. tumor
Axillary view

80. tumor
CT scan

81. Amputation specimen cut in path lab

82. Photomic

83. Case #506
25 year male
parosteal OGS
distal femur

84. Distal femoral
resection specimen
tumor

85. tumor
Cut specimen
in path lab
fatty
marrow

86. Case #507
13 year male
parosteal OGS
mid femur
AP view

87. Lateral view

88. CT scan

89. Segmental resection specimen

90. Autoclaved bone replaced with IM nail fixation

91. Post op x-ray
2 years later
Autoclaved
bone

92. Case #508
17 year male with parosteal OGS mid tibia

93. Lateral x-ray

94. tumor
CT scan

95. Bone scan

96. biopsy
site
Segmental resection
mid tibial lesion

97. tumor
Surgical specimen cut in path lab

98. Allograft reconstruction over IM nail

99. X-ray 1 year later

100. Case #509
41 year female
parosteal OGS
humerus

101. CT scan

102. tumor
Resected cut specimen in path lab

103. Case #509.1 Parosteal OGS pseudotumor M.O.
10/06 3/07
17 year male with football injury 9/06

104. Sag T-1 Sag Gad

105. Axial T-1
Axial Gad

106. Case #510
32 year female with high grade parosteal OGS femur

107. Macro section
tumor

108. Photomic

109. Periosteal
Osteogenic
Sarcoma

110. Periosteal Osteosarcoma
The periosteal osteosarcoma is another surface type OGS that
tends to be low grade to intermediate with potential for pulmonary
metastasis in about 25% of cases. It accounts for 2% of all OGS’s
and, compared to the parosteal OGS, has a much higher percentage
of cartilagenous tissue in the tumor to the point where it can look
like a periosteal chondroma but with a much higher mitotic index.
One must find a few areas of osteoid formation to classify this as
a periosteal OGS. It is seen typically in the second decade of life
and is slightly more common in females than males. It arises from
long bones, typically the tibia or femur, and has a higher incidence
in diaphyseal bone than does OGS. Like the parosteal OGS, this
lesion is treated by aggressive wide local resection that often can
spare the adjacent joint. In most cases chemotherapy is not utilized
unless the clinical picture is more aggressive than usual.

111. CLASSIC Case #112
15 year female with periosteal OGS tibia

112. CT scan

113. tumor
Sagittal CT scan

114. Axial T-2 MRI

115. Photomic

116. Post op x-ray following
wide resection and
allograft reconstruction

117. Case #112.1 Periostel OGS
17 yr male with tender lump on tibia for 8 mos.

118. Sag T-1 Gad

119. Axial T-1 Gad

120. Case #511
30 year male with periosteal OGS prox tibia

121. CT scan

122. Sagittal T-2 MRI

123. edema
tumor
Axial T-1 MRI

124. Wide resection
proximal tibia
tumor
bulge

125. tumor
Cut specimen
in path lab

126. Photomic

127. Proximal tibia resected ready for reconstruction

128. Post op x-ray with
alloprosthetic TKA
reconstruction
allograft

129. Case # 512
9 year female
periosteal OGS
tibia

130. AP x-ray

131. Lateral view

132. Cut specimen in
path lab following
AK amputation

133. Photomic

134. Higher power

135. Case #513
14 year male
periosteal OGS

136. Sagittal T-2 MRI

137. Axial T-1 MRI

138. Axial T-2 MRI

139. Case #514
26 year female
periosteal OGS
distal femur

140. Lateral view

141. stress
shielding
X-ray 10 years
following wide
resection and cemented
prosthetic reconstruction

142. Case #515
12 year female
periosteal OGS
tibia

143. Bone scan

144. Axial T-1 MRI

145. Photomic

146. Case #516
15 year male
periosteal OGS
distal tibia

147. CT scan

148. Bone scan

149. Photomic

150. Case #517
Nora’s lesion
39 year female
periosteal OGS
pseudotumor
In fact is a Nora’s
lesion or
bizarre parosteal
osteochondromatous
proliferation (BPOP)

151. Bone scan

152. CT scan

153. edema
Axial Gad contrast MRI

154. Sagittal PD

155. Sagittal T-2 MRI
edema

156. Axial gad contrast MRI

157. Pagetic Sarcoma

158. Pagetic Sarcoma
There are multiple diseases of the skeletal system that can result
in a secondary form of OGS most likely brought about by a second
mutation at a later age in a patient with chronic benign disease.
These diseases include Paget’s disease, osteoblastoma, fibrous
dysplasia, benign giant cell tumor of bone, bone infarcts, and
chronic osteomyelitis. The most common of this group is Paget’s
disease, a non-specific inflammatory osteomyelitis of bone seen
in older patients that may be induced by a virus infection. Approx-
imately 1% of patients with Paget’s disease can go on to Pagetic
OGS which accounts for 3% of all OGS. The most common
location for this secondary form of OGS is in the humerus,
followed next by the pelvis and femur. The patients typically have a
long history of dull, aching pain from their inflammatory Paget’s
disease but then suddenly develop an acute new pain in the area of
the older pain with x-ray evidence of recent lysis and destruction

159. of old Pagetic reactive bone. The prognosis for survival in this
secondary form of OGS is extremely poor with only about 8%
surviving, mainly because the older age group in which the disease
occurs make it impractical to implement the aggressive protocols
used in younger age groups.

160. CLASSIC Case #113
tumor
80 year female with Pagetic sarcoma pelvis

161. Bone scan

162. tumor
Axial T-2 MRI

163. osteoid
Photomic

164. Post op internal hemipelvectomy

165. Case#518
tumor
83 year female
Pagetic sarcoma
pelvis

166. tumor
CT scan

167. tumor
Another CT cut

168. Photomic

169. Case #519
85 year female with Paget’s disease pelvis

170. Same disease in
lumbar spine

171. Same disease
in skull

172. Same disease in tibia
Advancing osteolytic wedge

173. old Paget’s
Same patient with
Pagetic sarcoma
humerus
new
tumor

174. Macro section
from amputation
specimen tumor

175. Photomic

176. Post op x-ray following forequarter amputation

177. Case # 520
73 year female
Pagetic sarcoma skull
ready for resection

178. Lateral view of skull

179. Occipital view

180. Tangential view

181. tumor
Resected specimen cut in path lab

182. Photomic

183. Case #521
old Paget’s
with prior
fracture
82 year male
Pagetic sarcoma
distal humerus

184. tumor
Close up of new tumor

185. Photomic

186. Case #522
80 year female
Pagetic sarcoma
distal humerus

187. Case #523
femur
humerus
84 male with multi focal Pagetic sarcoma

188. Case #524
83 year male
Pagetic sarcoma
femur

189. Case #525
60 year male
Pagetic sarcoma
femur

190. Lateral view

191. Photomic

192. Photomic

193. Case #526
78 female
Pagetic sarcoma
proximal tibia

194. Lateral view
tumor

195. Case #527
92 year male
Pagetic sarcoma tibia

196. Case #528
78 year female
Pagetic sarcoma
lumbar spine

197. Low Grade
Intramedullary
Osteogenic
Sarcoma

198. Low Grade Intramedullary OGS
Low grade intramedullary OGS is another rare low grade fibro-
osseous variant of OGS that is unique because it is totally confined
within the cortical anatomy of a long bone, most typically around
the knee joint. It is found in an older age group than the classic
OGS and is typically seen between the ages of 15 and 55 years;
it affects males and females equally. The radiologic picture is that
of a diffuse sclerotic change within the metaphysis of the long
bone with no periosteal response or lytic destruction of the cortical
anatomy. The smoky appearance of metaphyseal bone suggests
the diagnosis of chronic osteomyelitis or perhaps fibrous dysplasia.
Microscopically, the tumor has a histological appearance similar
to parosteal OGS and because of this carries the same excellent
prognosis for survival as we see in parosteal sarcoma. Likewise,
treatment is similar without the use of chemotherapy or radiation.
These lesions must be treated with complete wide resection that
frequently involves a TKA, similar as in the classic OGS.

199. CLASSIC
Case #114
63 year female
intramedullary OGS
distal femur

200. Lateral view

201. Bone scan

202. tumor
CT scan

203. tumor
Macro section from
resected specimen

204. Photomic

205. Photomic

206. Case #528.1
51 year female tumor
low grade
intramedullary OGS
distal femur

207. Bone scan

208. Coronal T-1 MRI
tumor

209. tumor
Axial T-1 MRI

210. tumor
Resected distal femur cut in path lab

211. Photomic

212. Case #529
32 year female tumor
low grade
intramedullary OGS
distal femur

213. Lateral view

214. CT scan

215. Photomic

216. Case #530
56 year male
low grade tumor
intramedullary OGS
distal tibia

217. Lateral view tumor

218. Bone scan

219. Photomic

220. Radiation-induced
Osteogenic
Sarcoma

221. Radiation-induced Osteosarcoma
One of the most malignant forms of OGS is the secondary type
induced by radiation therapy, usually over 3000 rads, for some
type of either benign or malignant disease process in the past.
One of the most common types of radiation-induced OGS is
seen in patients with breast cancer who receive local radiation
following radical mastectomy and than develop OGS in the
shoulder girdle area. Other malignant diseases that can result in
OGS after radiation therapy include Ewing’s sarcoma and
lymphomas. Benign diseases that can result in OGS from
radiation therapy include GCT, ABC, and fibrous dysplasia. The
average delay for the occurrence of secondary OGS is 15 years,
with a range from 3 to 55 years. The prognosis for this variant is
extremely poor, similar to Pagetic OGS. It has a very high rate
of metastasis to the lung for which chemotherapy is not very
effective.

222. CLASSIC
Case #115
33 year female
radiation-induced
sarcoma scapula

223. tumor
Widely resected specimen cut in path lab

224. scapula
tumor
Close up

225. Photomic

226. Higher power

227. Post op x-ray following scapular wing resection

228. Case #531
tumor
35 year female with radiation sarcoma prox femur
prior radiation treatment for Hodgkin’s 20 yrs ago

229. Frog leg lateral
tumor

230. Shortly after with
pathologic fracture

231. tumor
Biopsy photomic

232. Higher power

233. Case #532
72 year male
radiation sarcoma pelvis
Prior radiation therapy
for prostate cancer
3 years before

234. Another view at a
different date with
hip dislocation

235. Photomic

236. Case #532.1 Radiation induced OGS
79 yr male with prior prostate CA radiation therapy
and now presents with radiation OGS

237. Coronal Anterior CT Posterior CT

238. L Sagittal CT scan R Sagittal CT scan

239. Low axial CT
cut thru L hip
showing large tumor
Upper CT cut thru
SI area showing
tumor R post ilium

240. Metastatic disease seen on chest x-ray

241. Case #533
56 year female with radiation sarcoma scapula
Prior history of radiation for breast cancer

242. Oblique view

243. Bone scan

244. Photomic

245. Case #534
tumor
63 year female with radiation sarcoma scapula
with prior radiation treatment for breast CA 12 yrs ago

246. Case #535
44 year female with
radiation sarcoma
proximal humerus 2nd
to prior radiation for tumor
breast cancer

247. Photomic with radiation OGS

248. Case #536
76 year male
radiation sarcoma
femur
Prior history of
radiation therapy
for soft tissue tumor
10 years ago

249. Bone scan

250. Photomic radiation OGS

251. Case #537
Elderly M.D. with long
history working under
X-ray fluoroscope
Now skin cancer and
radiation sarcoma
index finger

252. X-ray of index
finger sarcoma
tumor

253. Photomic radiation sarcoma

254. Multicentric
Osteogenic
Sarcoma

255. Multicentric Osteosarcoma
The multicentric variant of OGS is an extremely rare variant
occurring in approximately 1% of all OGS. It has two distinct
categories: (1) Synchronous multicentric OGS occurring in child-
hood and adolescence. This is the more severe variant, considered
to be extremely high grade with a very poor prognosis associated
with it. This form presents with multiple sclerotic lesions seen in a
fairly symmetrical fashion in long bones, mostly in the lower
extremities and because of the heavy tumor burden associated
with multiple lesions throughout the skeleton, the alkaline phos-
phatase is frequently elevated. (2) Metachronous multicentric OGS
occurring mainly in adults is less aggressive than the synchronous
form seen in children, presenting usually with a solitary lesion.
Then, later on, more lesions develop that are considered multi-
focal in nature. The possibility of metastasis can not be ruled out.
These forms of OGS are quite resistant to chemotherapy and
surgical treatment is frustrating because of the multi focal disease.

256. CLASSIC
Case #116
8 year female
multicentric OGS

257. Close up distal femur

258. Lateral view

259. Bone scan

260. Close up
bone scan

261. Upper body
bone scan

262. Coronal T-1 MRI

263. Another coronal cut
T-1 MRI

264. Sagittal T-1 MRI

265. Photomic

266. Another photomic

267. Case #116.1 Multicentric OGS
Cor STIR Bone scan
13 yr male with left knee pain for last 3 mos

268. Sag T-1 PD Gad

269. Axial T-1 T-2
Gad

270. Sag T-1 T-1

271. CT lung

272. Case #538
18 year female
multicentric OGS
pelvis and femur

273. tumor
tumor
Gad contrast coronal MRI

274. Another Gad contrast cut

275. pelvic
tumor
Axial T-2 MRI

276. Internal Hemipelvectomy
Recon plate placed across pelvic ring surgical defect

277. Placement of air screws just prior to cementation

278. cement
Placement of cement around screws and plate

279. femoral implant
total
hip
Constrained total hip in and securing muscles
to custom proximal femoral replacement implant

280. acetabulum
tumor
bulge ilium
Outer face of resected specimen

281. tumor
bulge
ilium
Inner face

282. Closure

283. recon plate
and screws
Post op x-ray

284. Case #539
16 year female
multicentric OGS tumor
Proximal tibial lesion

285. Lateral view with
skip lesion in
distal tibia

286. Bone scan showing two lesions in tibia

287. Bone scan showing
iliac lesion

288. Bone scan showing
sternal lesion

289. Photomic from tibial biopsy

290. Proximal tibial
resection and tumor
total knee bulge
reconstruction

291. Proximal tibial
prosthesis in position
ready for relocation
and closure

292. Reconstruction
completed and
ready for closure

293. Case #540
Multicentric OGS
femur and sacrum
20 year male

294. Lateral view

295. Coronal T-1 MRI
showing tumor at
both ends of femur

296. Sagittal T-1 MRI
distal femur
tumor

297. tumor
Axial T-2 MRI distal femur

298. Another axial T-2 MRI

299. Bone scan

300. Coronal T-1 MRI

301. Axial T-1 MRI

302. tumor
Coronal gad contrast MRI showing sacral lesion

303. Photomic from femoral biopsy

304. Case #541
10 year female with multicentric OGS femur and tibia

305. tumor
Lateral view

306. skip
lesion
AP view femur
tumor

307. tumor
Coronal T-2 MRI
distal femur

308. tumor
Sagittal T-2 MRI
distal femur
tibial
lesions

309. tumor
Coronal T-1 MRI
knee joint
tumor

310. tumor
Coronal T-1 MRI showing multicentric involvement

311. Case #542
tumor
15 year male with multicentric OGS tibia and femur

312. tumor
Coronal T-1 MRI
tumor

313. Coronal T-2 MRI
tumor

314. Sagittal T-1 MRI
tumor

315. tumor
Axial T-2 MRI view of distal femur

316. Soft Tissue
Osteogenic
Sarcoma

317. Soft Tissue Osteosarcoma
OGS can be seen in soft tissue outside the skeletal system. It
accounts for 4% of all OGS and is typically in large muscle groups
around the pelvis and thigh area. It occurs most often in patients
over 40 years of age and hits males and females equally. Soft
tissue OGS, with its mature appearing bone in the central area of
the lesion and aggressive, poorly mineralized tissue at the
periphery, must be differentiated from myositis ossificans, which
has a typical zonal pattern with peripheral maturation of bone
formation. As with any soft tissue sarcoma, the treatment consists
of wide local resection. Because of the poor prognosis, worse
than that of bone osteosarcoma, systemic chemotherapy is utilized
extensively as one would use for a typical medullary OGS.

318. CLASSIC
Case #118
tumor
67 year male
soft tissue OGS
calf

319. AP view

320. Sagittal T-1 MRI
tumor

321. Axial T-1 MRI

322. Cut surgical specimen in path lab

323. Photomic

324. Case #543
76 year female
soft tissue OGS
calf

325. Lateral view

326. CT scan

327. Bone scan

328. Axial T-1 MRI

329. Sagittal T-1 MRI
tumor

330. Photomic

331. Case #544
60 year female with
soft tissue OGS leg

332. Oblique view

333. Bone scan

334. Case #545
63 year male
soft tissue OGS
hand tumor

335. Lateral view

336. tumor
Axial T-1 MRI

337. tumor
Axial T-2 MRI

338. tumor
Coronal T-2 MRI

339. Multiple pulmonary mets

340. Intracortical
Osteogenic
Sarcoma

341. Intracortical Osteosarcoma
The intracortical OGS is perhaps the rarest variant of OGS with
only 14 cases described in the world literature since 1960. It
occurs between the ages of 10 and 47 years, equally between
males and females, and is seen most typically in the femur or
tibia as a metadiaphyseal lesion with a radiographic appearance
very similar to that of osteoid oasteoma. The prognosis is usually
quite good with a total of three deaths in the world literature. It
is usually treated by wide resection without chemotherapy. A
few cases are higher grade and carry a poor prognosis similar
to the classic OGS.

342. CLASSIC Case #119
42 year female with intracortical OGS femur

343. Bone scan

344. Axial PD MRI

345. Sagittal T-2 MRI

346. Early biopsy photomic

347. X-ray 18 months
after curettement
with recurrence

348. Bone scan at time of recurrence

349. Axial Gad contrast MRI same time

350. tumor
Sagittal PD MRI
same time

351. tumor
Unicortical segmental wide resection

352. Photomic of resected specimen

353. Post op x-ray following allograft
unicortical resection
and allograft recon

354. PD T-2
tumor
Sagittal PD & T-2 MRI 18 months later with met to C-spine

355. Case #546
43 year female
intracortical OGS
distal femur

356. Lateral view

357. Sagittal T-1 MRI

358. tumor
Sagittal T-2 MRI

359. Biopsy photomic

360. Photomic

361. Case #547
47 year female
intracortical OGS
humerus

362. Lateral view

363. CT scan

364. tumor
Sagittal T-1 MRI

365. Post op x-ray after
wide resection and
allograft recon