Periosteal tibial osteosarcoma with pulmonary dissemination and exceptional cardiac metastasis: Case Report and and Imaging Review”

Periosteal osteosarcoma is a rare malignant bone tumor belonging to the group of surface osteosarcomas. It differs from conventional forms by its periosteal origin, intermediate grade, and distinct biological behavior.
We report the case of a 14-year-old female patient with no significant past medical history, who presented with progressive leg pain evolving over one month. The pain was inflammatory in nature, associated with unquantified weight loss and limping.
Initial evaluation included plain radiography, followed by computed tomography (CT) and magnetic resonance imaging (MRI) of the left leg, which revealed an aggressive metaphyso-diaphyseal tumor of the left tibia, highly suggestive of periosteal osteosarcoma.
A surgical biopsy was subsequently performed, confirming the diagnosis on histopathological examination.
The patient was managed with neoadjuvant chemotherapy . However, the clinical course was marked by tumor progression with locoregional extension, leading to the indication for transfemoral amputation.
This procedure was refused by the patient’s family. The subsequent course was unfavorable, with the development of pulmonary metastases as well as a rare secondary cardiac involvement.