OBJECTIVE. Our purpose was to describe four female patients with osteosarco
ma whose clinical and imaging findings primarily suggested either simple or
aneurysmal bone cyst. All lesions were osteolytic, intracompartmental, and
expanded bone without periosteal reaction. None of the patients presented
during the peak age incidence for osteosarcoma. From imaging to histologic
diagnosis, the discovery of osteosarcoma ranged from 1 week to 3 years.
CONCLUSION. Atypical osteosarcoma may rarely mimic simple or aneurysmal bon
e cyst radiologically and may show a nonmalignant rate of growth. It may be
more frequently encountered in females and may not present during the peak
age incidence for osteosarcoma, Microscopically, the tumors were not cysti
c, necrotic, or telangiectatic but were conventional osteosarcoma and osteo
clast-rich osteosarcoma.