Juxtacortical osteosarcoma: a radiologic and histologic spectrum.

Radiologic and pathologic findings were analyzed in four patients with parosteal osteosarcomas, three with periosteal osteosarcomas and one with a high-grade surface osteosarcoma. Plain film and histologic findings considered together are usually distinctive and permit differentiation of these tumors from each other and from other lesions with which they are frequently confused. Prognosis and management are determined by tumor extent and histologic grade. Computed tomography is more accurate than conventional tomography, angiography, and bone scintigraphy for preoperative determination of tumor extent and for assessing tumor relationships to the bone cortex and medullary cavity. Histologically, parosteal osteosarcomas are usually low-grade, while periosteal and high-grade surface osteosarcomas are generally high-grade tumors and have worse prognoses. High-grade surface osteosarcoma, which is indistinguishable in behavior and histology from classical medullary osteosarcoma, requires more aggressive surgical management than parosteal and periosteal osteosarcomas.