Radiological findings
Lateromedial, dorsopalmar, dorsomedial-palmarolateral and
dorsolateral-palmaromedial oblique views were obtained from the left
metacarpal region (Fig 1b and c) . A large expansile
multicavitary mass was present at the proximomedial aspect of the third
metacarpal bone with an excessive heterogeneous periosteal reaction
characterized by multiple trabeculae. The borders of the mass exhibited
a combination of indistinct and well-defined margins. The mass extended
from the dorsomedial to the palmaromedial region of the third metacarpal
bone and affected the dorsal edge of the second metacarpal bone as well
with cortical destruction and well-defined geographic lysis involving
the palmaromedial mid-diaphysis of the metacarpus II and III. The cortex
of the second metacarpal bone was almost breached, but its distal and
proximal parts remained intact. Based on the pathognomonic radiological
signs, the most likely diagnosis was an osteosarcoma, and therefor
surgical excision under general anesthesia, followed by
histopathological tissue examination was recommended.