Osteosarcoma arising in Paget's disease of the calvarium

Paget's disease of the bone occasionally transforms into sarcomatous tumors such as osteosarcoma. While Paget's disease demonstrates markedly increased uptake of bone scanning radiopharmaceutical, osteosarcomas complicating this condition often show decreased uptake. An unusual scan appearance of the osteosarcoma is presented in which the tumor showed intense uptake of the tracer on the bone scan. The extent of the sarcoma as delineated by the bone scan corresponded closely to the size of the lesion as seen on computerized tomography and magnetic resonance imaging and was confirmed at surgery.