This is a case report on the remarkable 23-year course of a metachronous osteogenic sarcoma in a 31-year-old man. Histology invariably showed the features of a high-grade osteogenic sarcoma with predominantly chondroblastic cells. During the observed period the patient developed nine osseous metastases. The quiescent clinical course of some metastases was in sharp contrast to the histological pattern. The patient finally died from symptoms of increasing cervical spinal cord compression without ever developing lung metastases.