Appearance of lung metastasis from osteosarcoma 21 years after initial treatment

This report describes a case of metastasis to the lung 21 years after the initial treatment of primary osteosarcoma in a 79-year-old man. The osteosarcoma was in the right femur and had resulted in amputation. The patient presented with painless hematuria, and a workup revealed a squamous cell carcinoma of the urinary bladder with invasion into the perivesicular fat. The patient received radiation therapy. Follow-up computed tomography of the chest revealed a nodule measuring 21x14 mm in the right upper lobe of the lung. Repeated transbronchial lung biopsies and needle biopsies were unsuccessful, so wedge resection of the right upper nodule was performed by video-assisted thoracic surgery to obtain a definitive diagnosis. The final pathological diagnosis was consistent with metastasis from the primary osteosarcoma removed 21 years earlier.