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Investigations

Authoring team

Biochemistry:

  • raised ESR and alkaline phosphatase

Radiography - findings are variable but look for:

  • alternating areas of osteolysis and osteosclerosis
  • poorly defined endosteal margin
  • breaching of the cortex - with:
    • sunray spicules - new bone breaches the cortex and radiates outwards, like a sunburst, into adjacent soft tissue
    • Codman's triangle - periosteum lifted into a triangle as the tumour emerges through the cortex
  • breaching of the cortex is characteristic but not pathognomonic
  • chest radiology may reveal pulmonary metastases - present in about 30 - 40% of patients at first presentation

CT and MRI reliably show the extent of the tumour.

Biopsy is essential to confirm the diagnosis before embarking on treatment.

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