Radiographically Occult Latent Radiogenic Osteosarcoma Uncovered on Tc-99m Methylene-diphosphonate Bone Scintigraphy

We present a case of a 70-year-old male who was referred for a technetium-99m methylene-diphosphonate bone scan for mild left hip pain and an elevated alkaline phosphatase level of 770 units/L. No additional information was provided and the patient's history was limited due to a language barrier. We were able to ascertain that the patient had a remote history of prostate cancer, which had been treated with radiation. Originally, we felt the bone scan was compatible with Paget's disease; however, further work-up revealed the presence of osteosarcoma, which was potentially radiation-induced.