Fine-needle aspiration biopsy of skeletal versus extraskeletal osteosarcoma

Dog breeds and conformations predisposed to osteosarcoma in the UK: a VetCompass study

BACKGROUND

Osteosarcoma is a malignant bone neoplasia that has high welfare consequences for affected dogs. Awareness of breed and canine conformational risk factors for osteosarcoma can assist with earlier diagnosis and improved clinical management. Study of osteosarcoma in dogs also offers translational value for humans. Anonymised clinical data within VetCompass on dogs under primary veterinary care in the UK were searched for osteosarcoma cases. Descriptive statistics reported overall and breed-specific prevalence. Risk factor analysis used multivariable logistic regression modelling.

RESULTS

From 905,552 study dogs, 331 osteosarcoma cases were confirmed yielding a one-year period prevalence of 0.037% (95% CI: 0.033-0.041). Breeds with the highest annual prevalence were the Scottish Deerhound (3.28%, 95% CI 0.90-8.18), Leonberger (1.48%, 95% CI 0.41- 3.75), Great Dane (0.87%, 95% CI 0.43- 1.55) and Rottweiler (0.84%, 95% CI 0.64-1.07). The median age at diagnosis was 9.64 years (IQR: 7.97-11.41). Following multivariable modelling, 11 breeds showed increased odds of osteosarcoma compared with crossbred dogs. Breeds with the highest odds included Scottish Deerhound (OR 118.40, 95% CI 41.12-340.95), Leonberger (OR 55.79, 95% CI 19.68-158.15), Great Dane (OR 34.24, 95% CI 17.81-65.83) and Rottweiler (OR 26.67, 95% CI 18.57-38.29). Compared with breeds with mesocephalic skull conformation, breeds with dolichocephalic skull conformation (OR 2.72, 95% CI 2.06-3.58) had increased odds while breeds with brachycephalic skull conformation showed reduced odds (OR 0.50, 95% CI 0.32-0.80). Chondrodystrophic breeds had 0.10 times the odds (95% CI 0.06-0.15) compared with non-chondrodystrophic breeds. Increasing adult bodyweight was associated with increasing odds of osteosarcoma.

CONCLUSIONS

The current study cements the concept that breed, bodyweight and longer leg or longer skull length are all strong risk factors for osteosarcoma in dogs. With this awareness, veterinarians can update their clinical suspicion and judgement, breeders can select towards lower-risk animals, and researchers can robustly define more useful study populations for fundamental and translational bioscience.

A Rare Case of Extraosseous Osteosarcoma (EOS) of Parotid Gland

Extraosseous osteosarcoma is a rare malignant soft tissue neoplasm, and extraosseous osteosarcoma of the parotid gland is very rare. It has a very aggressive course, and there are no standardized treatment guidelines. We report the case of a 20 year old male patient who presented with history of right neck swelling since 6 years for which he had undergone right parotid surgery 5 years ago. The final histopathological report indicated that the mass was a pleomorphic adenoma. One year after the first surgery, the patient experienced recurrence of swelling over the operated site, and the size of the swelling has been increasing gradually since then. He was evaluated clinically, and a large mass was noted over the upper aspect of the right upper neck, extending to the occipital and parotid regions. An MRI scan was done which showed a 12 × 10 × 8 cm lesion centred in the right parotid gland, involving paraspinal muscles, C1-C2 vertebrae and extending into the parapharyngeal space. FNAC of the lesion showed features of pleomorphic adenoma. The patient underwent a complete excision of the tumour. The patient's post-operative period was uneventful. The final histopathological report of the patient was extraosseous osteosarcoma of the parotid gland. The patient was referred for adjuvant radiotherapy. He has been on regular follow-up for the past 6 months and has shown no sign of recurrence. EOS is an extremely rare tumour of the head and neck region which often requires extensive surgical resection with or without adjuvant radiotherapy. It has a high rate of local recurrence and a very low disease free survival. Such patients should be kept on a close follow-up.

Giant cell tumor of soft tissue: FNA cytopathology of 4 cases, review of the literature, and comparison with giant cell tumor of bone

BACKGROUND

The cytopathology of a giant cell tumor of soft tissue (GCT-ST), a fibrohistiocytic neoplasm distinct from other giant cell-rich soft tissue tumors, is rarely reported. The authors report their experience with a series of 4 GCT-ST fine-needle aspiration (FNA) biopsy cases and compare them with a set from giant cell tumors of bone (GCTBs).

METHODS

The authors' cytopathology files were searched for GCT-ST examples with histopathologic confirmation. FNA biopsy smears were performed and examined with standard techniques.

RESULTS

Four cases of GCT-ST presenting as a primary soft tissue mass from 4 patients (3 males and 1 female; age range, 28-75 years, mean age, 53 years) were retrieved. FNA sites included the anterior tibia, buttock, shoulder, and upper back. Three cases were interpreted as suspicious for sarcoma radiographically. The specific diagnoses were atypical giant cell tumor of tendon sheath, suspicious for GCT-ST, atypical myxoid lesion with giant cells, and benign with osteoclast-like giant cells (OLGCs). No case was interpreted as malignant. Aspirates consisted of mononuclear polygonal cells, spindled fibroblast cell clusters, and large OLGCs to the near exclusion of other cell types. OLGCs possessed 10 or more nuclei per cell. A comparison with GCTB aspirates and single case reports from the literature showed comparable cytomorphology.

CONCLUSIONS

GCT-ST FNA smears mimic those of GCTBs containing a limited population of uniform spindle cell clusters, single dispersed polygonal cells, and cytologically banal OLGCs. GCT-ST should be considered in the differential diagnosis of aspirates containing numerous osteoclast-like giant cells.

Cytological diagnosis of osteosarcoma with emphasis on diagnostic pitfalls

INTRODUCTION

Fine needle aspiration is a well-established technique for evaluating primary and secondary bony lesions. With use in selected cases, it achieves a diagnostic yield comparable to biopsies.

METHODS

Cases of osteosarcoma (OS) with available histological follow-up were retrieved over a 10-year period. Detailed morphological evaluation was done, with special emphasis on pitfalls in the diagnosis of OS on cytology and the various variants of OS.

RESULTS

Of the 41 cases with available follow-up histology, 56% were correctly diagnosed as OS on cytology. The most common false-negative cytological diagnosis of OS, in 17% cases, was giant cell tumour. The possible explanations for this included low cellularity, minimal atypia, absence of typical osteoid, misinterpretation of metachromatic osteoid material as fibro-collagenous material and non-availability of radiology at time of aspiration.

CONCLUSION

A triple-phase evaluation including clinical evaluation, appropriate radiological correlation and cytology/histopathology, is important to clinch an accurate diagnosis.

The role of ultrasound-guided fine needle aspiration biopsy in musculoskeletal diseases

Ultrasonography (US) is a readily available non-invasive tool useful for the detection of musculoskeletal and soft tissue masses. Although X-Ray is often the first imaging study for evaluating both bone and soft tissue lesions, and magnetic resonance imaging and computed tomography are mandatory in lesions staging, US is increasingly used for the early assessment of musculoskeletal and soft-tissue masses and for guiding procedures and biopsies. Surgical biopsy or fine needle aspiration biopsy (FNAB) is needed to ascertain the nature of any lesion. FNAB is a low cost technique, safer and less traumatic than an open surgical biopsy. Significant complications are rare, mostly related to the site of biopsy. Knowledge of indications, limitations, anatomical and pathological access, adequate technical expertise in US imaging and in intervention skills are the critical factors of the appropriate and safe use of FNAB. By now, the role of FNAB in musculoskeletal diseases is controversial and there is still a heated debate in the scientific community.

Osteoblastic Extraosseous Osteosarcoma of the Neck

Extraosseous osteosarcoma as a primary tumor of the neck is exceedingly rare, with only a few cases reported to date. The most appropriate therapy is still under investigation. We report a case of an aggressive, right-sided, advanced-stage extraosseous osteosarcoma in a female patient. A 48-year-old woman presented with a right-sided infra-parotid mass encompassing neck regions II and III, measuring over 6 cm in craniocaudal diameter. She was initially treated by wide surgical resection. The definitive histopathologic diagnosis was osteoblastic extraosseous osteosarcoma. Computed tomography at initial presentation did not show signs of tumorous growth in other areas. The patient was treated with adjuvant chemoradiotherapy postoperatively. A local recurrence with intraspinal propagation was noted 4 months after surgery, and a second surgical attempt was made to remove the tumor. The disease recurred in the neck and spine 3 months after the second surgical procedure, and a final unsuccessful attempt at reducing the tumor mass was performed. The tumor site was reirradiated. The patient died of local disease propagation 3 months later. Extraosseous osteosarcoma of the neck is an extremely rare tumor, distinct from primary osteosarcoma of the bone, with a high rate of local recurrence and poor prognosis in advanced disease.

Bone Cytology: A Realistic Approach for Clinical Use

This article presents the use of bone cytology for diagnosis of bone tumors. It discusses critical factors and considerations of fine-needle aspiration and bone cytology and presents diagnostic options and differential diagnosis for benign and malignant bone lesions. Osteomyelitis, chrondroblastoma, Langerhans cell histiocytosis, chondromyxoid fibromas, enchondromas, giant cell tumor of bone, osteosarcoma, chondrosarcoma and variants, Ewing sarcoma, chordoma, plasmacytoma, multiple myeloma, lymphoma, and metastatic bone disease are presented.

Extraosseous osteosarcoma in the neck

BACKGROUND

Extraosseous osteosarcoma arising in the head and neck region is an exceptional finding, with a few isolated cases informed in the literature. We report a new case of a large high-grade extraosseous osteosarcoma located in the neck.

CASE PRESENTATION

A 74 year-old woman with a tumor on the right side of the neck was treated by complete surgical resection. The histopathological diagnosis was osteoblastic extraosseous osteosarcoma. PET-CT scan disclosed no evidence of disease in other areas. Patient received adjuvant radiotherapy and after 3 months of follow-up tumor activity was detected in the cavernous sinus and the patient died of disease one month later.

CONCLUSION

Extraosseous osteosarcoma in head and neck region is exceptional, and incisional biopsy is the only method to establish a diagnosis and the one to differentiate it from other bone-producing soft tissue tumors. Surgery is the gold standard for treatment of extraosseous osteosarcoma.

Cyto-histological correlations inprimary, recurrent, and metastatic bone and soft tissue osteosarcoma. Institut Curie's experience

To determine diagnostic cytomorphologic features of osteosarcoma on fine-needle aspiration materials, we reviewed the cytologic material and corresponding histologic slides of 126 tumors in 107 patients. Fifty-five (43.6%) tumors were primary, 31 (24.6%) were recurrent, and 40 (31.8%) were metastatic. Review of original cytology reports revealed that 120 (95.3%) tumors were diagnosed as malignant. Six (4.7%) cases were reported as suspicious, false-negative, or unsatisfactory samples. Our findings showed that osteoblastic roundish cells, spindle-shaped cells, reactive giant cells, and osteoid were the most consistent features representative of osteosarcoma. Periosteal reactions, fractures with callous formation, giant cells of osteoclastic type in various conditions, chondrosarcoma with enchondral ossification are entities to consider in the differential diagnosis.

Fine-needle aspiration of primary osteosarcoma: A cytological-histological study

This study aims to determine the diagnostic accuracy of fine-needle aspiration (FNA) evaluation of primary osteosarcoma (OS) and to review diagnostic criteria and adjunctive methods that can contribute to a confident diagnosis of OS in cytological smears. We evaluated FNA smears of OS in 59 patients for the following: cytomorphology and occurrence of osteoid, usefulness of adjunctive methods in evaluation of FNA smears and correspondence of FNA to the clinical data, and the histological features of excised tumors. Reliable cytological criteria of malignancy were found in 49 smears of high-grade OS. These criteria, correlated with radiographic studies and complemented by ancillary techniques, allowed diagnosis of OS or suspicion of OS in 44 cases. An additional four smears were diagnosed as sarcoma and one case was diagnosed erroneously as being carcinoma metastasis. There were no false positive or false negative diagnoses. We conclude that FNA smears from high-grade OS have characteristic features, which together with clinical and radiological data and ancillary studies allow correct diagnosis in most tumors.

Biology and therapeutic advances for pediatric osteosarcoma

Osteosarcoma is the most common malignant bone tumor in children and adolescents. Survival for these patients was poor with the use of surgery and/or radiotherapy. The introduction of multi-agent chemotherapy dramatically improved the outcome for these patients and the majority of modern series report 3-year disease-free survival of 60%-70%. This paper describes current strategies for treating patients with osteosarcoma as well as review of the clinical features, radiologic and diagnostic work-up, and pathology. The authors review the state of the art management for patients with osteosarcoma in North America and Europe including the use of limb-salvage procedures and reconstruction as well as discuss the etiologic and biologic factors associated with tumor development. Therapy-related sequelae and future directions in the biology and therapy for these patients are also discussed.

Recommendations for the reporting of bone tumors

The diagnosis of a bone tumor is often an arduous task, even for the most experienced orthopedic pathologist. As a starting point, the classification of bone tumors is based on a histogenetic perspective encompassing the type of matrix produced (or not produced) by the tumor. In general, the surgical pathology report should include data pertinent to the treatment and prognostication of an individual patient, and the report should be delivered to the clinician in a clear, concise fashion. Reporting of most bone tumors is similar and includes such information as the type of surgery done, anatomic site, histological type and grade of the tumor (if applicable), and the adequacy of surgical margins. Special emphasis is needed for those tumors with distinct and well-established prognostic and therapeutic features such as osteosarcoma and Ewing's sarcoma/peripheral neuroectodermal tumor. Our recommendation emphasizes a standardized protocol for these sarcomas, especially in light of evidence that postchemotherapeutic tumor necrosis is of prognostic significance. It is also important to note that radiographic imaging plays a very important, often critical, role in allowing the pathologist the opportunity to reach the best final diagnosis. This is especially true when a malignant interpretation is contemplated and in subtyping lesions. We recommend close collaboration between musculoskeletal radiologists, clinicians, and pathologists when dealing with complicated neoplasms of bone.

Fine-needle aspiration biopsy of solid aneurysmal bone cyst in the humerus

We report the fine-needle aspiration biopsy (FNAB) cytology findings of a solid aneurysmal bone cyst in the left humerus of a 69-yr-old woman. Radiographically, the lesion showed an extensive, relatively well-defined osteolysis in the diaphysis, with a pathologic fracture. FNAB smears of the lesion consisted of benign, mononuclear cells and numerous osteoclast-like multinucleated giant cells. Some clusters of the mononuclear cells were closely associated with dense, homogeneous, extracellular, matrix material. To our knowledge, the FNAB features of solid ABC of the long bones have not been described previously in the English-language literature. The cytologic features are indistinguishable from those of giant cell tumors of bone and brown tumors of hyperparathyroidism.

Cytologic diagnosis of ossifying fibromyxoid tumor of soft tissue: A case report

Ossifying fibromyxoid tumor (OFMT) of soft tissue is an uncommon, recently described neoplasm. It is usually, but not universally, a benign neoplasm and cases of metastatic so-called "malignant OFMT" have been reported. Although the histopathologic features of OFMT are well characterized, the same is not entirely true so far as the cytology literature is concerned. There are only three cytologic descriptions of OFMT to date to the best of our knowledge. A 62-year-old woman presented with a subcutaneous well-circumscribed nodular soft tissue mass at the upper end of the shoulder. X-ray and computed tomography revealed an incomplete shell of calcification surrounding the nodular mass along with foci of ossification within it. Fine-needle aspiration (FNA) cytology showed round to polygonal to spindle shaped neoplastic cells arranged in clusters, cords, and small aggregates and lying discretely in a mucoid background. Some osteoid-like material was also seen. The tumor was completely excised and histopathologic examination confirmed the diagnosis of OFMT. OFMT should be considered as a possibility in FNA cytology of myxoid soft tissue tumor especially with radiologic evidence of ossification.

Utility of fine-needle aspiration in the diagnosis of primary osteosarcoma

Fine-needle aspiration (FNA) is a reliable, safe, and cost-effective procedure with a well-established role in the diagnosis of various solid tissue neoplasms. The role of FNA in the diagnosis of primary bone tumors, including osteosarcoma (OGS), is controversial and has yet to be established. We reviewed our experience with the use of FNA as a diagnostic technique over the past 8 yr at our institution. Diagnosis was conclusive in 26 (65%) of 40 patients, 18 of whom went to neoadjuvant therapy and/or resection based solely on the FNA interpretation of either "high grade sarcoma" or "osteosarcoma." Of the remaining 14 (25%) patients, 12 had inconclusive diagnosis and two (5%) were false-negatives. An inconclusive diagnosis was most likely to be an inadequate or paucicellular aspirate, seen in six (15%) patients. An additional six patients had variants of osteosarcoma (four chondroid, one "giant cell rich," one parosteal) that made definitive diagnosis impossible. The two that were incorrectly classified were diagnosed as fracture callus and plasmacytoma. FNA is an accurate and cost-effective tool for the initial diagnosis of primary osteosarcoma with a sensitivity of 65% and accuracy of 95%. Inconclusive diagnoses are likely to be due to insufficient sample cellularity or the presence of OGS variant. In our experience, FNA is sufficient to provide the diagnosis of OGS prior to definitive treatment when interpreted in conjunction with imaging studies and clinical findings. In those cases where FNA fails to yield a diagnostic sample, a traditional biopsy can be performed.

Scrape and fine-needle aspiration cytology of extraskeletal osteosarcoma

Extraskeletal osteosarcoma is a rare malignant soft tissue tumor whose cytologic findings are infrequently reported. We describe scrape and fine-needle aspiration biopsy (FNAB) cytology findings of an extraskeletal osteosarcoma in the right shoulder of a 24-yr-old man. Initial computed tomography revealed multiple ossification foci within the lesion. After excision of the primary tumor, the tumor recurred 13 months later. Scrape smears of both the primary tumor and FNAB smears of the recurrent tumor revealed moderate cellularity, cell clusters, and individual cells, closely associated with dense, homogeneous, acellular matrix material. The cells had elongated, oval, or partially bizarre-shaped nuclei with a coarse chromatin pattern and prominent nucleoli. The scrape smears contained large fragments of matrix material consistent with osteoid.

Fine-needle aspiration biopsy of sarcomas and related tumors

BACKGROUND

Largely due to a lack of experience, familiarity, and/or confidence, few centers rely on simple fine-needle aspiration biopsy (FNAB) for the diagnosis of sarcomas and related tumors.

METHODS

The authors have reviewed their own experience in more than 200 cases of FNAB of bone and soft-tissue tumors, as well as cases reported in the literature.

RESULTS

FNAB has proven to be accurate and useful in 8 consecutive years of clinical experience. No serious complications have occurred.

CONCLUSIONS

FNAB is recommended as an integral part of the initial evaluation of amenable orthopaedic tumors, including sarcomas, especially in cases with classic clinical and radiographic findings.