Which X-ray appearance is associated with osteosarcoma?

Which X-ray appearance is associated with osteosarcoma?

• A. Sunburst pattern
• B. Onion skin periosteal reaction
• C. Lytic moth-eaten with sequestra
• D. Periosteal elevation only

Answer: (A)

Osteosarcoma typically shows a sunburst periosteal reaction on X-ray, created when the tumor grows rapidly and elevates the periosteum, causing radiating spicules of new bone to extend from the cortex into surrounding soft tissue. This pattern reflects the aggressive osteoid-producing activity of the malignant osteoblasts. You may also see a Codman triangle, where the raised periosteum forms a triangular area at the lesion edge—both features point to rapid, destructive bone formation. Other patterns belong to different conditions: an onion skin appearance is classic for Ewing sarcoma; lytic moth-eaten with sequestra suggests chronic osteomyelitis; periosteal elevation alone can occur in a variety of processes and isn’t as specific. Hence, the sunburst pattern is the most characteristic radiographic sign of osteosarcoma.

Osteosarcoma typically shows a sunburst periosteal reaction on X-ray, created when the tumor grows rapidly and elevates the periosteum, causing radiating spicules of new bone to extend from the cortex into surrounding soft tissue. This pattern reflects the aggressive osteoid-producing activity of the malignant osteoblasts. You may also see a Codman triangle, where the raised periosteum forms a triangular area at the lesion edge—both features point to rapid, destructive bone formation. Other patterns belong to different conditions: an onion skin appearance is classic for Ewing sarcoma; lytic moth-eaten with sequestra suggests chronic osteomyelitis; periosteal elevation alone can occur in a variety of processes and isn’t as specific. Hence, the sunburst pattern is the most characteristic radiographic sign of osteosarcoma.