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Background. Parosteal osteosarcoma is a rare low-grade bone tumour. The operation material must undergo a careful patohistological analysis, because the extent of invasion of the medullar cavity and most probably the extent of dedifferentiated areas determines the prognosis and occurrence of local recurrence and metastases. Patients and methods. In this retrospective clinical study, 7 cases of parosteal osteosarcoma of the bone have been analyzed. Six patients were with parosteal osteosarcoma and one with periosteal osteosarcoma. The study was performed at the Clinic for Orthopedic Surgery in Skopje, Macedonia, from 1995 to 2006 This tumour represents 1.5% of all 467 patients with primary bone tumours treated at the Clinic in the 12 year period. The age of 7 patients (3 female and 4 male) ranged from 8 to 39 years (median 27). The history analysis of the patients showed the misinterpreted diagnosis in 57% of the cases, with 71.4 % rate of local recurrence, 28.7% of metastases and 28.7% of mortality. The follow-up varied from 7 months to 9 years (median 37 months). Results. The clinical and histopathological findings of this study (same as those reviewed in the literature) confirmed the occurrence of two biologically different types of parosteal osteosarcoma: the predominant type is originally "benign" but has a definite malignant potential, causing metastases after the long symptom-free interval. The other type is highly malignant from the beginning. Conclusions. The compartmental, radical "en bloc" resection, followed by the regular review of the patients, is recommended for the low malignant type, however, the radical surgery, followed by chemotherapy, is recommended for the highly malignant tumours.

Purpose: To correlate radiologic imaging diagnosis with histopathology in cases with soft tissue musculoskeletal lesions. Before ultrasound (US)-guided core needle biopsy, radiologic imaging diagnosis was done using multimodality imaging. Correlation of histopathologic Method: diagnoses after biopsy and surgical specimen was done. Prospectively, 100 consecutive patients (53 males, 47 females, median age 51 years) with a musculoskeletal soft tissue mass underwent US, computed tomography (CT) and magnetic resonance (MRI). US-guided core needle biopsy was done in all patients. Fifteen MRI parameters and corresponding parameters on US and CT were evaluated for making a radiologic diagnosis. Multivariate logistic regression analysis was used for imaging parameters predictive for malignancy. Histopathologies after biopsy were correlated with radiologic diagnosis in all patients Results: There were and with the surgical specimen in 92% of the cases. 70 benign lesions (53 benign tumors and 17 tumor-like lesions) and 30 malignant lesions(26 malignant tumors and 4 metastases). The overall imaging accuracy for benign and malignant tumors was 92%. Nine cases (9%) were false-positive (4 benign tumors, 1 tumor-like lesion and 4metastases) and 2 (2%) were false-negative. The correlation between imaging staging and histopathology was 63.6% for malignant tumors. MRI had the highest diagnostic accuracy (89%) compared with US (78%) and CT (83%). A diagnostic imaging algorithm was created. Histopathology after Conclusion: A combination biopsy correlated in all surgical specimens. of individual multimodality imaging parameters improved radiologic imaging diagnosis in differentiation between benign and malignant soft tissue musculoskeletal lesions. US-guided core needle biopsy is recommended as the procedure of choice for obtaining representative specimens of soft tissue musculoskeletal tumors for histological examination because of its high diagnostic accuracy and low complication rate.

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