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Subcutaneous nodules as initial metastatic sites in osteosarcoma

A 54‐year‐oid woman presented with two nonsymptomatic subcutaneous nodules. Approximately 3 months previously, after sustaining a fall, her X‐rays revealed a pathologic fracture and a highly destructive appearing lesion. She underwent amputation of the right leg up to the middle of the femoral bone. Her history was negative for any pre‐existing bone condition and her famiiy history was negative for malignant diseases. The pathology report macroscopically showed a neoplastic tumor with a maximal diameter of 12 cm which literally occupied almost all of the knee arthrosis and extended into the femoral condylus. Microscopic examination of the specimen showed a high grade malignant sarcoma comprising mainly spindle cells with a large percentage of necrosis. The exact histologic typing was uncertain, but was probably fibroblastic‐type osteosarcoma (Fig. 1).