The central areas of the bars stain more deeply due to their mineralization. The bars are much thicker than primary trabeculae of reactive or dysplastic bone and are arranged in a nonstress-oriented, haphazard pattern. The pattern, or architecture, of the bars accounts for the amorphous appearance of neoplastic bone grossly and radiographically. Such lesions, however, have the same natural history and response to therapy as their more-conventional counterparts. In classic osteosarcoma, a wide, en bloc excision is indicated if the patient is responsive to preoperative chemotherapy, but radical resection or amputation are necessary if the patient is unresponsive.
Pulmonary metastases are often resectable.
This is a radiograph of the reconstruction done with an osteoarticular allograft following a wide resection of a classic osteosarcoma of the distal femur in a patient who was a satisfactory responder to preoperative chemotherapy. The extent of the resection is shown in . This classic, Stage II-B osteosarcoma of the distal femur was treated with a radical hip disarticulation in the era before chemotherapy was available. The same management would be prudent currently if a similar lesion was nonresponsive to chemotherapy. His postoperative, functional result was excellent .