CTICasesTelangiectatic Osteosarcoma
Imaging findings
Chest CT demonstrates a massive, expansile soft-tissue tumor arising from and destroying the left sixth rib. The tumor extends extensively into the chest wall and thoracic cavity, associated with a large left pleural effusion and compressive atelectasis. There is a lack of dense, mineralized osteoid matrix within the mass. A follow-up scan shows new ossified pleural-based implants along the diaphragmatic surface, consistent with metastatic pleural seeding.
Key takeaways
Telangiectatic osteosarcoma is a rare subtype of osteosarcoma characterized by multiple aneurysmal, blood-filled spaces separated by septa containing malignant cells. Because it is highly destructive and contains minimal osteoid matrix, it can easily mimic an aneurysmal bone cyst, giant cell tumor, or hematoma on imaging. Chest wall involvement can lead to secondary pleural seeding (droplet metastases), which often contain calcification/ossification.
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