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Wen X, Xue L, Jiang X, Jiang J, Li M, Zhang L. Case report: A 17-year-old male with primary pulmonary osteosarcoma. Front Med (Lausanne) 2024; 11:1364937. [PMID: 38576713 PMCID: PMC10991813 DOI: 10.3389/fmed.2024.1364937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Primary pulmonary osteosarcoma is one of the extraskeletal osteosarcomas originating from the lung with an extremely low incidence and highly invasive potential. Here we report a case of primary pulmonary osteosarcoma treated in our hospital with a literature review. The patient, a 17-year-old male, had a cough and hemoptysis for 20 days. Computed tomography (CT) and positron emission tomography (PET)/CT were performed in our hospital. According to pathological examination after surgery, the tumor was diagnosed as a high-grade sarcoma with remarkable osteogenesis and necrosis. Based on radiological and histological examinations, a diagnosis of primary pulmonary osteosarcoma originating was considered. The patient underwent surgery and adjuvant chemotherapy. This patient has been under consecutive follow-up for nearly 8 years, showing no signs of recurrence or distant metastasis. Primary pulmonary osteosarcoma is a rare lung malignancy that shows rapid progression, nonspecific symptoms and inapparent signs at an early stage. The diagnosis of primary pulmonary osteosarcoma highly relies on imaging and histological examinations, among which chest CT is the predominant method to check this disease.
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Affiliation(s)
- Xin Wen
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyan Xue
- Department of Pathology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Jiang
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiuming Jiang
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Li
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Diagnostic Radiology, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Huang W, Deng HY, Li D, Li P, Xu K, Zhang YX, Weng JH, Zhou Q. Characteristics and prognosis of primary pulmonary osteosarcoma: a pooled analysis. J Cardiothorac Surg 2022; 17:240. [PMID: 36171612 PMCID: PMC9520935 DOI: 10.1186/s13019-022-02010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary pulmonary osteosarcoma (PPOS) is an uncommon malignancy originating from the lung with low incidence, and its clinical characteristics and prognosis have not been systematically reported. Therefore, we aimed to recognize the prognostic factors and constructed a survival prediction model for PPOS. METHODS We collected the data from the Surveillance, Epidemiology, and End Results database and systematic review of previous studies. Demographical and clinical characteristics, radiographic manifestations, treatment modalities, and prognosis were analyzed. A prediction model via nomogram was constructed and then evaluated by the concordance index (C-index) and the receiver operating characteristic (ROC) curve. RESULTS A total of 49 cases were included for analysis with a median age of 67 years old (range 33-94 years), of which 32 (65.3%) were male. The median size was 6 cm (range 1.8-25 cm), and the median overall survival (OS) was eight months (interquartile range 4.5-12 months) with a 1-year OS rate of 30.8%. Tumor size over 7 cm (hazard ratio [HR] = 2.98; P = 0.018) and those without microscopic findings of osteoid found in the tumors (HR = 2.11; P = 0.048) were referred to a poor OS, while surgery was associated with an improved OS (HR = 0.20; P < 0.001). The C-index of the nomogram prediction model was 0.771, and the area under curve, sensitivity and specificity of the ROC curve were 0.818, 0.848 and 0.800, respectively. CONCLUSIONS Patients with PPOS had a poor prognosis, and tumor size was mostly prognostic. Surgery seemed to be an effective treatment, and the prediction model with a nomogram in our study could effectively predict the prognosis of patients with PPOS.
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Affiliation(s)
- Weijia Huang
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Deyan Li
- Operation Room, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Peiwei Li
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Kai Xu
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yu-Xiao Zhang
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Jia-Hui Weng
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.
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Abstract
A case of primary osteogenic sarcoma of the breast is reported. It should be distinguished from carcinoma with extensive osseous metaplasia. The results of light and electron microscopy including an immunohistochemical study are presented. Immunohistochemical and ultrastructural studies proved that the lesion, in the absence of epithelial differentiation, was a primary osteogenic sarcoma of the breast rather than a carcinoma with extensive osseous metaplasia. Diagnosis may be delayed because the tumor is confused clinically and mammographically with a calcific fibroadenoma.
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Affiliation(s)
- S Bianchi
- Istituto di Anatomia e Istologia Patologica, Università degli Studi di Firenze, Italy
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Qian J, Zhang XY, Gu P, Shao JC, Han BH, Wang HM. Primary thoracic extraskeletal osteosarcoma: a case report and literature review. J Thorac Dis 2017; 9:E1088-E1095. [PMID: 29312772 DOI: 10.21037/jtd.2017.11.111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary extraskeletal osteosarcoma (ESOS) presenting in thoracic locations is very rare and associated with a poor prognosis. The current study presents a case involving a large anterior mediastinal mass, which was histologically confirmed as a primary osteosarcoma. The literature concerning primary thoracic ESOS is reviewed. A total of 60 cases were identified. The median age was 60 years (range, 14-93 years) and males were more prevalent among the reported cases (65%). Survival analysis revealed that the overall 5-year survival was only 22.3%. The majority of cases of thoracic ESOS presented in the lung (n=24, 40%), with others presenting in the mediastinum, pleura, or chest wall. The benefit of surgery, chemotherapy and radiotherapy was confirmed by Cox regression survival analyses.
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Affiliation(s)
- Jie Qian
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xue-Yan Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Ping Gu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jin-Chen Shao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Bao-Hui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Hui-Min Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
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Abstract
Purpose. Primary extra-osseous osteosarcomas are uncommon lesions, and those originating within the lung are especially rare, with few case reports existing in the literature.Patient. We report the case of a 48-year-old male smoker with a primary osteosarcoma of the right lower lung lobe.Results. Diagnosis was based on histopathological findings of a poorly differentiated sarcoma with malignant cellular components of osteoid and chondroid matrix, along with immunohistochemical and electron microscopy confirmation. Extensive clinical and radiographic evaluation failed to reveal any tumor at other anatomical sites.
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Affiliation(s)
- M S Wagner
- Pathology & Laboratory Service Veterans Affairs Hospital Hines Illinois USA
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Wajstaub S, Bezjak A, Howarth D, King MH, Catton CN. A radio-sensitive primary osteosarcoma in the lung. Int J Clin Oncol 2010; 16:67-70. [PMID: 20711855 DOI: 10.1007/s10147-010-0113-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 07/05/2010] [Indexed: 11/26/2022]
Abstract
We report an unusual case of a primary osteosarcoma of the lung in an asymptomatic 77-year-old male, who underwent lobectomy with complete resection of the lung lesion. His pattern of relapse was to multiple lymph nodes. The first relapse was 11 weeks after lobectomy in subcarinal lymph nodes, confirmed on needle aspiration to be consistent with sarcoma. Given his excellent performance status, this was treated with radical radiotherapy to 70 Gy in 35 fractions with good control. He relapsed to other lymph node regions. A biopsy of the external iliac lymph node was done and revealed osteoid production, consistent with osteosarcoma. He received palliative radiotherapy to several nodal areas with good clinical response. We review the literature of this rare tumor with an unusual pattern of relapse.
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Affiliation(s)
- Sandra Wajstaub
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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8
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Shenjere P, Travis WD, Franks TJ, Doran HM, Hasleton PS. Primary Pulmonary Osteosarcoma: A Report of 4 Cases and a Review of the Literature. Int J Surg Pathol 2009; 19:225-9. [DOI: 10.1177/1066896909332382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary pulmonary osteosarcoma is very rare. Most cases are secondary deposits from primaries arising in the appendicular skeleton. Four cases of primary osteogenic sarcoma of the lung are described and the literature reviewed for previously reported cases. These pulmonary tumors occur in patients who are in their fourth to seventh decades, that is, an older age group than their primary bone equivalent. There is a slight male predominance. There appears to be a propensity for the left lung, especially the left upper lobe. The clinical presentation is similar to primary (epithelial) lung cancer. Differentiation from pleomorphic carcinomas and other sarcomas is discussed. We know of no predisposing factor(s) in our cases for the development of this tumor.
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Affiliation(s)
- Patrick Shenjere
- Department of Histopathology, Christie Hospital, Wilmslow Road, Manchester, United Kingdom,
| | - William D. Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York
| | - Teri J. Franks
- Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, D.C
| | | | - Philip S. Hasleton
- Department of Histopathology, Manchester Royal Infirmary (PSJ), Manchester, United Kingdom
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9
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Primary osteosarcoma of the lung: a case report and review of the literature. Med Oncol 2007; 25:251-5. [DOI: 10.1007/s12032-007-9022-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 10/03/2007] [Indexed: 11/26/2022]
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Kadowaki T, Hamada H, Yokoyama A, Katayama H, Abe M, Nishimura K, Tomiyama N, Kito K, Miyazaki T, Higaki J. Two cases of primary pulmonary osteosarcoma. Intern Med 2005; 44:632-7. [PMID: 16020895 DOI: 10.2169/internalmedicine.44.632] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Two cases of primary pulmonary osteosarcoma are presented. In both cases, chest computed tomography revealed a calcified pulmonary mass and technetium-99m methylene diphosphonate bone scintigraphy showed intense uptake in the pulmonary mass. Primary pulmonary osteosarcoma was suspected on the basis of these radiographic findings. Microscopic examination of tumor specimens obtained by needle biopsy revealed histologic features of osteosarcoma, and this diagnosis was confirmed by postmortem examination of a second specimen in each case. Radiographic and histopathological findings enabled us to diagnose primary pulmonary osteosarcoma, which is one of the rarest types of cancer.
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Affiliation(s)
- Toru Kadowaki
- Second Department of Internal Medicine, Ehime University School of Medicine, Onsengun
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Chapman AD, Pritchard SC, Yap WW, Rooney PH, Cockburn JS, Hutcheon AW, Nicolson MC, Kerr KM, McLeod HL. Primary pulmonary osteosarcoma. Cancer 2001. [DOI: 10.1002/1097-0142(20010215)91:4<779::aid-cncr1064>3.0.co;2-j] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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Lin J, Ho J, Chan A, Yeo W, Yip KM, Johnson PJ. Extraosseous osteogenic sarcoma of the mediastinum occurring in a Chinese patient. Clin Oncol (R Coll Radiol) 1995; 7:200-1. [PMID: 7547527 DOI: 10.1016/s0936-6555(05)80518-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Osteogenic sarcoma can occur rarely in soft tissues, predominantly of the proximal lower limbs. The mediastinum is a less common site, with only five reports in the literature. We report a case occurring in a young Chinese man and review the literature.
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Affiliation(s)
- J Lin
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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Connolly JP, McGuyer CA, Sageman WS, Bailey H. Intrathoracic osteosarcoma diagnosed by CT scan and pleural biopsy. Chest 1991; 100:265-7. [PMID: 2060361 DOI: 10.1378/chest.100.1.265] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Osteosarcoma rarely presents as a primary lesion in the chest, whereas pulmonary metastases are common. The diagnosis of primary intrathoracic osteosarcoma has invariably been by thoracotomy or autopsy. We present a case of a densely calcified, primary intrathoracic osteosarcoma where diagnosis was made antemortem by pleural biopsies and computed tomography scan.
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Affiliation(s)
- J P Connolly
- Department of Internal Medicine, Naval Hospital, San Diego, California 92134-5000
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15
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Catanese J, Dutcher JP, Dorfman HD, Andres DF, Wiernik PH. Mediastinal osteosarcoma with extension to lungs in a patient treated for Hodgkin's disease. Cancer 1988; 62:2252-7. [PMID: 3052784 DOI: 10.1002/1097-0142(19881115)62:10<2252::aid-cncr2820621030>3.0.co;2-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article reports a patient with Hodgkin's disease in remission after combined modality therapy who developed metastatic pulmonary osteosarcoma, subsequently found to originate in soft tissue of the mediastinum, within a field irradiated 11 years previously. This patient developed a series of radiotherapy-induced complications in addition to osteosarcoma. Only 16 cases of extraskeletal osteosarcoma after radiation treatment have been reported, none originating in the mediastinum. To the authors' knowledge, this is the first reported case of extraskeletal osteosarcoma occurring in a patient previously treated for Hodgkin's disease and with the sarcoma originating within the irradiated field.
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Affiliation(s)
- J Catanese
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY 10461
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16
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Abstract
A large variety of neoplasms can produce calcified lung metastases. Three unusual examples are presented and the relevant literature is reviewed. Each case involves a neoplasm not previously reported to produce calcified lung metastases: malignant mesenchymoma, fibrosarcoma of the breast, and medullary carcinoma of the thyroid. The sarcomas are reported in the literature to develop calcified lung metastases are osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumour. Among carcinomas, the papillary and mucinous adenocarcinomas are the histological types most likely to develop calcified lung metastases. The metastases of a number of other tumours have calcified after antineoplastic therapy. Calcification in metastases arises through a variety of mechanisms: bone formation in tumour osteoid, calcification and ossification of tumour cartilage, dystrophic calcification and ossification of tumour cartilage, dystrophic calcification and mucoid calcification. Since calcified lung metastases can strongly resemble granulomas or hamartomas, a reasonable suspicion of malignancy is necessary when evaluating calcified pulmonary nodules.
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Abstract
In an example of mixed malignant mesenchymal tumor of the cerebellar vermis, striking osteoblastic differentiation was present along with extensive intradural spinal invasion. The CNS sarcomas and their variants are discussed as well as the extraskeletal osteosarcomas. Comparison is made to the teratoid tumors and other mixed and unusual posterior fossa tumor elements, and the capability of midline posterior fossa tissues for multipotential differentiation is considered.
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Ikeda T, Ishihara T, Yoshimatsu H, Kikuchi K, Murakami M. Primary osteogenic sarcoma of the mediastinum. Thorax 1974; 29:582-8. [PMID: 4530480 PMCID: PMC470204 DOI: 10.1136/thx.29.5.582] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Ikeda, T., Ishihara, T., Yoshimatsu, H., Kikuchi, K., Murakami, M., Kobayashi, K., Inoue, H., and Kasahara, M. (1974). Thorax, 582-588. Primary osteogenic sarcoma of the mediastinum. A 22-year-old man with primary osteogenic sarcoma of the superior mediastinum is reported. This case is the second instance of primary osteogenic sarcoma of the mediastinum and the first case of superior mediastinal origin to be reported. The patient had local recurrence one year after the first operation. After resection of the recurrent tumour with left upper lobectomy and partial pericardectomy followed by radiation, he has been well for more than five years without recurrence. Extraosseous osteogenic sarcoma of soft tissue is very rare and has been reported in 103 patients. The five-year survival of patients with extraosseous osteogenic sarcoma is 22·4%. The distribution and prognosis of this tumour are similar to those of rhabdomyosarcoma in soft tissue. Primary amputation or wide excision is the treatment of choice.
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