Young girl aged nine years , presented with tender lower end of right femur : 4 months duration. Swelling observed since 15 days . 

Clinical possibilities 

1. Osteomyelitis 
2. Osteogenic Sarcoma 

Preoperative Imaging

Heterogeneous mass arising from distal metaphysis of the right femur with a soft tissue component 

Preoperative needle biopsy 

High grade Osteogenic sarcoma  with a chondroblastic  differentiation . 

PET CT

FDG avid sclerotic lesion involving distal meta diaphysis of the right femur with parosteal  reaction extending to the soft tissue with hypo dense area within the lesion 

Size 6.7 cm * 8.9cm * 12.3cm ( AP*T*CC ) SUV max 11.5

Joint space uninvolved 

No skip lesion 

Retroperitoneal nodes reactive 

No lung nodules

Preoperative Diagnosis 

No metastatic osteogenic sarcoma 

Treatment 

Preoperative CTRT

Surgery 

DePuy total femur replacement 

Rehabilitation 

FWB + Knee ROM abduction pillow + Deroration boot for 6 weeks + sitting up till 60 degree 

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