Primary leiomyosarcoma of bone.

We report a case of primary leiomyosarcoma in the right femoral diaphysis. Conventional radiographs revealed an indistinct osteolytic lesion with a very subtle periosteal reaction. MR imaging revealed an intramedullary lesion with a well-defined margin, cortical breakthrough and soft tissue extension. The lesion was isointense relative to muscle on T1-weighted imaging, iso-hypointense relative to fat on fast spin echo T2-weighted imaging, and hyperintense to muscle on fast spin echo T2-weighted imaging with fat saturation. A peripheral rim and intratumoral spoke-wheel-like enhancement in the soft tissue component of the tumor was noted on gadolinium-enhanced T1-weighted imaging with fat saturation. Such an enhancing pattern, which has not been described in the literature previously but has been seen in leiomyosarcomas elsewhere by both MR imaging and computed tomography, deserves further pathological correlation.