The most common sites in order of frequency are the distal femur, proximal tibia, proximal fibula, and proximal humerus. May also involve flat bones like the ileum and mandible. On film see cortical bone destruction with lysis and sclerosis and an associated soft tissue mass with foci of calcification. Codman's triangle is the classic sign of malignant periosteal reaction. MRI is best for establishing the medullary extent of the tumor.
Bone scan shows skeletal metastases best.
Chest CT is best at determining the presence of lung metastases. See References Chapter. All rights reserved.