Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

: 1999  |  Volume : 9  |  Issue : 2  |  Page : 89--90

Ossified lymph node metastases from osteosarcoma

Krishnankutty Nair Ramachandran, Kochuvelu Sasidharan, Vadavattathu P Gangadharan, Anandavally Sivanandan Krishnakumar 
 Department of Medical Oncology, Regional Cancer Centre, Trivandrum, India

Correspondence Address:
Krishnankutty Nair Ramachandran
Department of Medical Oncology, Regional Cancer Centre, Trivandrum

How to cite this article:
Ramachandran K, Sasidharan K, Gangadharan VP, Krishnakumar A. Ossified lymph node metastases from osteosarcoma.Indian J Radiol Imaging 1999;9:89-90

How to cite this URL:
Ramachandran K, Sasidharan K, Gangadharan VP, Krishnakumar A. Ossified lymph node metastases from osteosarcoma. Indian J Radiol Imaging [serial online] 1999 [cited 2019 Aug 25 ];9:89-90
Available from:

Full Text


Lymph node metastases from osteosarcoma are a rare entity. Two patients with ossified lymph node metastases from osteosarcoma are presented with their clinical and radiological features. Both of them had inguinal lymph node involvement. Inguinal nodes were diagnosed by ultrasound and confirmed by CT. Ultrasound has not been used as an initial imaging modality in the past. Both these patients had histological confirmation.

Osteosarcoma is a primary malignant tumor of bone. No bone is exempt. There is a second peak in the sixties. Osteosarcoma is known to occur in pre-existing lesions such as Paget's disease, fibrous dysplasia and following irradiation. Metastases occurs mainly to the lungs. Lymph node metastases is rare. Radiographic detection of ossified lymph nodes is extremely rare.

A thirteen-years old girl presented with a painful swelling of the right knee for two months. Plain radiographs and CT revealed a malignant tumor of the lower end of the right femur with features suggestive of osteosarcoma. She had multiple swellings in the right inguinal region. US revealed multiple hyperechoic areas with shadowing which was suggestive of calcified lesions [Figure 1]. A plain radiograph of the pelvis and inguinal region confirmed the presence of multiple opacities along the vertical chain of the right inguinal lymph nodes [Figure 2]. Biopsy of the lymph nodes confirmed metastases from osteosarcoma.

A fifteen-years old boy presented with swelling of the right lower thigh for two months with enlarged right inguinal nodes. Plain radiographs and CT diagnosed a malignant bone tumor possibly osteosarcoma. Biopsy showed chondrosarcomatous type of osteosarcoma. Ultrasonogram of the enlarged inguinal lymph nodes revealed curvilinear hyperechoic areas with shadowing, suggestive of ossified lymph nodes. CT confirmed the diagnosis [Figure 3]. The biopsy report was ossified lymph node metastases from osteosarcoma.

Osteosarcoma constitutes 3% of all bone tumors. It shows a predilection for long bones around the knee in adolescents during the growth spurt period. Typically it is located eccentrically in the metaphysis [1]. Less aggressive surgical techniques such as limb conservation and new chemotherapeutic regimens have improved the outcome in this disease. Bone tumors either metastasize to other bones or to the lung [2],[3]. The hematogenous route is the main route of spread. Less than 10% of primary metastases occur in sites other than the lung [4]. The less common sites occurring preterminally or detected at autopsy include pleura, pericardium, kidney, adrenal glands and brain [5]. Radiographically detectable involvement of lymph nodes is extremely rare. However, isolated case reports have been published. Metastases to regional lymph nodes are so rare that it has been suggested they should be disregarded for purposes of therapy. Involvement of lymph nodes in osteosarcoma is a poor prognostic sign [5]. The metastatic lymph nodes are usually asymptomatic but in sites like the mediastinum they may cause dysphagia, bronchial erosion and compression. The significance of lymph nodes in sites like the inguinal region and axilla is difficult to ascertain. Ultrasound is very useful as an initial imaging modality for detecting lymph node involvement. It is also useful in suspecting the ossific nature of the lymph nodes.

In both our patients, the inguinal nodes were detected by ultrasound. Further confirmation was by plain radiographs and CT. The inguinal nodes were later biopsied and decalcified sections showed osteosarcoma.


1Thomas PS, Renton P, Hall C, Kalifa G, Dulousset J, Lalande G. The Musculoskeletal system. In: Carty H, Shaw D, Brunelle F, Kendall B. (eds.) Imaging children. Churchill Livinstone, Edin Burgh, 1994; 846-1302.
2Bernard G. Radiology of Bone Tumors. Ortho Clin North Am.1989; 20: 287-300.
3William AM Jr. Imaging of bone tumors in the 1990s. Cancer 1991; 67: 1167-1176.
4William FE, Dempsey SS. 'Osteosarcoma'. In: Tillman MM (ed) Orthop Clin North Am Symposium on tumours of the Musculoskeletal system, W B Saunders and Co 1977; 785-794.
5Michael PL, Federick E. Osteosarcoma. In: Piezo PA, Pollack D S (eds.) Principles and Practice of Paediatric Oncology. J B Lippincott and Co, Philadelphia, 1992; 689-711.