Secondary osteogenic sarcomas occur in the presence of a pre-existing condition in older individuals in both long bones as well as flat bones. The pre-existing condition may be Paget's disease, fibrous dysplasia, enchondromas, exostoses, osteomyelitis, bone infarct, bone fracture or previous irradiation. Patients with familial retinoblastoma, who have a hereditary mutation on the Rb suppressor gene on chromosome 13, are at risk of developing osteogenic sarcoma usually in an irradiated area of the bone. Clinically, these tumors present with local swelling, tenderness or bone pain. These tumors metastasize widely to the lung, other organs and bones.
Lymphatic metastasis is rare.
These tumors rarely destroy the epiphyseal plate. Some tumors are largely fibroblastic, some are mostly osteoblastic, some are chondroid and some are telangiectatic.