This patient's presentation, radiographs, and biopsy are consistent with telangiectatic osteosarcoma. Treatment is similar to classic osteosarcoma and initially includes multi-agent neoadjuvant chemotherapy (ex. adriamycin, cis-platinum, methotrexate, and ifosfamide) for 8-12 weeks followed by surgical resection (limb-salvage or amputation), followed by additional adjuvant chemotherapy for 6-12 months.
Capanna et al emphasizes that aneurysmal bone cyst's (ABC) occur in the same locations as telangiectatic osteosarcomas, and their radiographic appearances can be confused with each other. The treatment of ABC's are much different and includes intralesional curettage and bone grafting.
Illustration A shows a representative histology slide of an ABC as a comparison to telangiectatic osteosarcoma.
Gitelis S, McDonald D. Common benign bone tumors and usual treatment. In: Simon M, Springfield D, eds. Surgery for Bone and Soft Tissue Tumors. Philadelphia, PA: Lippincott-Raven; 1998:181-205.
Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts.Orthop Clin North Am. 1996 Jul;27(3):605-14. Review
PMID:8649741 (Link to Abstract)