Introduction
Osteosarcoma is commonest primary malignant bone tumor of unintelligible
origin, with peak age at 10-19 years old(1). The distal radius is a rare
site for osteosarcoma; it was reported less than <1% (2).
Between all the bone tumors, osteosarcoma have the widest variety in
clinical presentation, imaging findings, morphological and histological
features. The mainstream treatment is combination of chemotherapy and
surgical treatment which improved the overall prognosis in the last two
decades (3-4). However, mycetoma is a chronic cutaneous and subcutaneous
painless swelling caused by two major types of pathogens, either
bacterial type (actinomycotic) or fungus type (eumycotic) [5]. It is
the most common neglected disease of human in tropical and subtropical
areas among low socioeconomic individuals [5,6]. It involves the
skin and connective tissue. Painless destructive nature, late
presentation, poor response to treatment and high recurrence rate are
characteristic features of this disease. Among all the endemic
countries, Sudan have the highest incidence [6-8]. The chronic
inflammatory granuloma, various deformaties, disabilities and high
morbidity rate are the commonest known complications of mycetoma, the
disease can be potentially limb threatening in its late stage
[9,10]. Clinically, mycetoma starts as a small painless lump which
increase in size gradually, forming multiple sinuses with seropurulent
discharge and eventually multicolored grains appear [11]. Meticulous
Clinical assessment , radiological and histopathological analysis of
such lesion is important for a presice diagnosis and management,
especially when dealing with unclear osteo-articular lesion. Management
of mycetoma predominantly depends on the etiological agent, site and
extent of the disease [12]. This case review serves to exemplify the
importance of recognizing the similarities between these 2 lesions and
other rare features that will help differentiate between osteosarcoma
and mycetoma, also to highlight and demonstrate the destructive features
of bone involvement by mycetoma that usually associate with inadequate
assessment, and the impact of delayed presentation or late diagnosis to
the overall outcome.