Which tumor shows onion-skin periosteal reaction on radiographs?

Which tumor shows onion-skin periosteal reaction on radiographs?

• A. Osteomyelitis
• B. Ewing sarcoma
• C. Osteosarcoma
• D. Chondrosarcoma

Answer: (B)

Onion-skin periosteal reaction arises when the periosteum is rapidly lifted by a fast-growing lesion, laying down multiple layers of new bone. This laminated, concentric pattern is most characteristically seen with Ewing sarcoma, which commonly affects children and adolescents and often involves the diaphysis of long bones. Radiographs typically show the layered periosteal reaction with possible cortical destruction and a soft-tissue mass. Other tumors have different radiographic signatures—osteosarcoma often shows a sunburst pattern or Codman triangle from aggressive cortical reaction, while chondrosarcoma tends to have calcified chondroid matrix and different periosteal changes. Osteomyelitis can cause periosteal reactions as well, but the distinct onion-skin layering is a hallmark association with Ewing sarcoma.

Onion-skin periosteal reaction arises when the periosteum is rapidly lifted by a fast-growing lesion, laying down multiple layers of new bone. This laminated, concentric pattern is most characteristically seen with Ewing sarcoma, which commonly affects children and adolescents and often involves the diaphysis of long bones. Radiographs typically show the layered periosteal reaction with possible cortical destruction and a soft-tissue mass. Other tumors have different radiographic signatures—osteosarcoma often shows a sunburst pattern or Codman triangle from aggressive cortical reaction, while chondrosarcoma tends to have calcified chondroid matrix and different periosteal changes. Osteomyelitis can cause periosteal reactions as well, but the distinct onion-skin layering is a hallmark association with Ewing sarcoma.