Extraosseous osteogenic sarcoma following an intramuscular injection

Establishment and characterization of novel patient-derived extraskeletal osteosarcoma cell line NCC-ESOS1-C1

Extraskeletal osteosarcoma (ESOS) is a rare mesenchymal malignancy producing osteoid and bone in soft tissue without skeletal attachment. ESOS exhibits chemoresistance and poor prognosis, and is distinct from osseous osteosarcoma. The biological characteristics of ESOS are not fully understood, and patient-derived cell lines of ESOS are not available from public cell banks. Here, we established a novel cell line of ESOS and characterized its genetic and biological characteristics as well as examined its response to anti-cancer reagents. The cell line was established using tumor tissue from a 58-year-old female patient with ESOS, and named as NCC-ESOS1-C1. Phenotypes relevant to malignancy such as proliferation and invasion were examined in vitro, and genetic features were evaluated using the NCC Oncopanel assay. The response to inhibitors was monitored by screening of an anti-cancer reagent library. The cells constantly proliferated, showing spheroid formation and invasion capabilities. The NCC Oncopanel revealed the presence of actionable mutations in PIK3CA. Library screening revealed the presence of anti-cancer reagents with significant anti-proliferative effects on NCC-ESOS1-C1 at a low concentration. In conclusion, we established and characterized a novel ESOS cell line, NCC-ESOS1-C1. This cell line will be a useful resource for basic research and preclinical studies.

Subcutaneous infiltrative nodule at the injection site of low-molecular weight heparin simulating malignancy

Low-molecular weight heparins (LMWHs) are the standard agents used for the prevention and treatment of thromboembolic disorders. Despite their widespread use, reports on adverse effects from LMWHs are uncommon. The present report describes a 23-year-old woman with a 3.8-cm solitary, fibrofatty, poorly demarcated nodule involving the subcutaneous tissue of the infraumbilical abdominal wall that appeared 4 years after iterative local administration of LMWH. Microscopically, the nodule showed atypical cells, with bizarre nuclei in the septa of cellular fibrous tissue dissecting the adipose lobules, in the absence of any other malignant changes. To the best of our knowledge, this kind of LMWH-related lesion has not been previously reported. The lesion may result from the combination of an idiosyncratic reaction to the LMWH with local trauma being a probable promoting factor. Alternatively, this reactive proliferation may be entirely due to the trauma represented by repeated injections. This rare process could easily be confused with liposarcoma. As the clinical history of injections is often not provided in the requisition form, pathologists should be aware of this adverse effect from LMWH to avoid misdiagnosis and excessive treatment.

Origins of injection-site sarcomas in cats: the possible role of chronic inflammation-a review

The etiology of feline injection-site sarcomas remains obscure. Sarcomas and other tumors are known to be associated with viral infections in humans and other animals, including cats. However, the available evidence suggests that this is not the case with feline injection-site sarcomas. These tumors have more in common with sarcomas noted in experimental studies with laboratory animals where foreign materials such as glass, plastics, and metal are the causal agent. Tumors arising with these agents are associated with chronic inflammation at the injection or implantation sites. Similar tumors have been observed, albeit infrequently, at microchip implantation sites, and these also are associated with chronic inflammation. It is suggested that injection-site sarcomas in cats may arise at the administration site as a result of chronic inflammation, possibly provoked by adjuvant materials, with subsequent DNA damage, cellular transformation, and clonal expansion. However, more fundamental research is required to elucidate the mechanisms involved.

Extraosseous osteosarcoma in Ibadan: case series over a 20-year period

Extraosseous osteosarcoma (EOO) is a rare form of sarcoma. There have been few reports of cases and outcome from an African population.Out of 112 cases of sarcomas seen at the UCH, Ibadan between 1986-2005, 5 were EOO. All presented late on account of initial excision without histology and outcomes were poor. EOO occurs in the black population of Sub-Saharan Africa. The outlook for these patients is still bleak.

Primary cutaneous extraskeletal osteosarcoma under a previous electrodessicated actinic keratosis

Extraskeletal osteosarcoma represents approximately 1% of soft tissue sarcomas and approximately 4% of all osteosarcomas. It is therefore much rarer than osteosarcoma arising primarily in bone. Skin as a primary site has seldom been reported. This report describes an extraskeletal osteosarcoma of the skin under a previously electrodessicated actinic keratosis.

Extraosseous osteosarcoma: response to treatment and long-term outcome

PURPOSE

To evaluate the clinicopathologic features of extraosseous osteosarcoma (EOO), a rare soft tissue form of osteosarcoma, and to examine its response to multimodality therapy.

PATIENTS AND METHODS

The medical records of all patients with EOO evaluated at The University of Texas M.D. Anderson Cancer Center between 1960 and 1999 were reviewed for clinicopathologic factors, treatment, and outcome.

RESULTS

Sixty consecutive patients with EOO were identified, including 38 patients with localized (American Joint Committee on Cancer stages I to III) disease. The majority of patients presented with T2 tumors (n = 35, 58%), and 90% of tumors were located beneath the investing fascia. Twenty-seven patients with measurable and assessable disease were treated with doxorubicin-based chemotherapy (median doxorubicin starting dose, 75 mg/m(2); median number of cycles, four). The overall response rate was 19%, with two complete and three partial responses; one (6%) of 18 doxorubicin-treated patients who underwent subsequent surgery had a pathologic complete response. For the subset of 30 patients with localized disease treated at M.D. Anderson, the 5-year actuarial local recurrence-free, distant recurrence-free, event-free, and disease-specific survival rates were 82% (95% confidence interval [CI], 70% to 98%), 64% (95% CI, 43% to 93%), 47% (95% CI, 30% to 70%), and 46% (95% CI, 26% to 80%), respectively.

CONCLUSION

EOO should be considered clinically and therapeutically distinct from osseous osteosarcoma. Radiographic response rates and pathologic complete response rates to doxorubicin-based systemic therapy are low.

Extraskeletal osteosarcoma of the scalp

A rare case of extraskeletal osteosarcoma of the scalp in a 56-year-old woman is described. At presentation she was found to have an 8-cm diameter, tender, firm, exophytic scalp tumor. MRI scan confirmed absence of underlying skeletal origin and showed extension along the subcutaneous plane. The tumor was excised and the patient received post-operative chemotherapy. Histologically, the tumor showed classical features of an osteogenic osteosarcoma with focal fibroblastic areas. In addition, there were rhabdoid cells present, which showed paranuclear cytoplasmic immunoreactivity for epithelial membrane antigen. The patient developed metastatic disease 6 months after surgical excision.

Epidemiology of osteosarcoma and Ewing's sarcoma in childhood: a study of 305 cases by the Children's Cancer Group

BACKGROUND

The Children's Cancer Group conducted a case-control study to determine the role of a broad range of environmental and familial factors in the etiology of Ewing's sarcoma and osteosarcoma in children. These factors included radiation exposure and, for children with osteosarcoma, parental exposure to beryllium.

METHODS

The parents of 152 children with osteosarcoma and 153 children with Ewing's sarcoma were interviewed by telephone. Controls were obtained by random digit dialing and were matched to cases by age and race.

RESULTS

Female osteosarcoma patients had earlier onset of breast development (age 11.4 vs. 11.8 years, P=0.03) and menarche (age 12.1 vs. 12.5 years, P=0.002) but no significant differences in growth, whereas male osteosarcoma patients were similar in age at the onset of secondary sexual characteristics but reported significantly less weight gain during their growth spurt (6.6 vs. 11.7 kg, P=0.003). For children with Ewing's sarcoma, the growth spurt began earlier (age 12.1 vs. 12.7 years, P=0.12) and resulted in less weight and height gain (5.2 vs. 9.7 kg, P=0.002, and 10.2 vs. 12.7 cm, P=0.02, respectively) for males, but no differences were observed among females. For factors not related to growth and development (including a wide range of occupational, medical, and household exposures), there was little evidence of an etiologic role with respect to either tumor type.

CONCLUSIONS

Differences between cases and controls with respect to growth and development showed no consistent pattern. This study did not identify any important risk factors for either type of childhood bone tumor.

Soft tissue sarcomas of the head and neck associated with surgical trauma

Soft tissue sarcomas in the head and neck are rare. Aetiological factors relating to these tumours have not yet been identified. The association with von Recklinghausen's disease and with irradiation is however well recognized. In the literature it has been speculated that trauma may also play a role in the development of soft tissue sarcomas. In this article we present five patients with a history of surgical trauma at the site where a sarcoma later developed. Although we cannot prove a causal relationship, the relatively high incidence of possibly trauma-related soft tissue sarcomas in a series of 60 patients we have seen over a 30-year period, suggests that such a relationship could exist.

Extraskeletal osteosarcoma. A clinicopathologic review of 26 cases

The clinical records and histopathologic features in 26 cases of extraskeletal osteosarcoma (ESOS) diagnosed at M.D. Anderson Cancer Center (Houston) between 1950 and 1987 were reviewed. Presentation was usually that of an enlarging soft tissue mass. The thigh (11 cases), upper extremity/shoulder girdle (three cases), and retroperitoneum (three cases) were the most common anatomic sites. Tumor size ranged from 2.5 to 30 cm. The predominant histologic pattern was osteoblastic in four cases, chondroblastic in two, fibroblastic or pleomorphic malignant fibrous histiocytoma (MFH)-like in four, giant cell type MFH-like in one, and small cell in one. Various mixtures of these patterns were seen in the remaining 14 tumors. The telangiectatic pattern was not seen as the predominant component in any primary tumor but was observed as a minor component. Thirteen tumors recurred locally and 16 metastasized; five patients had distant metastases at presentation. The lungs, bone, and soft tissue were the most frequent metastatic sites. Sixteen patients died of disease at 2 to 54 months, one patient died of unrelated causes at 61 months, seven patients were alive with no evidence of disease (NED) at 30 to 122 months, and two patients were alive with disease at 28 and 54 months, respectively. Tumor size (less than 5 cm versus greater than or equal to 5 cm) was the main prognostic factor; all patients alive with NED for whom accurate tumor measurements were available (six of seven) had neoplasms measuring less than 5 cm that were amenable to complete surgical excision. Histologic pattern and other clinicopathologic features did not significantly affect outcome.

Osteogenic sarcoma of the tongue: case report with light and electron microscopy studies and review of the literature

A case of osteosarcoma of the tongue is reported, with microscopic findings. The patient underwent chemotherapy, left hemiglossectomy, and neck dissection, followed by radiotherapy. Five years after initial therapy, he is still alive and well, with no evidence of recurrence.

Extraskeletal osteosarcoma

A retrospective study of 88 cases of extraskeletal osteosarcoma revealed that this tumor affects adults almost exclusively, with a high incidence in patients older than 50 years, and is slightly more common in males (58%) than in female patients. The tumor occurred principally as a soft tissue mass in an extremity, with a predilection for the thighs (lower extremity, 46.6%; upper extremity, 20.5%) and the retroperitoneum (17%). Most were deep-seated and were firmly attached to the fascia, but occasionally they were freely movable and confined to the subcutis or dermis. Nearly all presented as an insidiously growing mass rarely causing pain or tenderness. The preoperative duration of symptoms ranged from 2 weeks to 25 years (median, 6 months). In 17 cases, it exceeded 2 years. A history of prior trauma to the site of the tumor was stated in 11 of the 88 cases (12.5%) and of radiation in five cases (5.7%). Microscopically, the tumors contained varying amounts of neoplastic osteoid and bone, sometimes together with islands of malignant-appearing cartilage. Like osteosarcoma of bone, extraskeletal osteosarcoma showed a striking variation in histologic appearance and focally resembled malignant fibrous histiocytoma, fibrosarcoma, and malignant schwannoma. Follow-up information was available for 65 patients. Eight (12.3%) patients were alive with no evidence of recurrence; 12 (18.5%) patients were alive with one or more recurrences; and five (7.6%) were alive with metastases. Twenty-eight of the tumors (43%) recurred and 39 (63%) metastasized. Forty (61.5%) of the patients with follow-up information had died, 36 from the tumor and four from miscellaneous causes. The prevailing sites of metastases were the lung, the regional lymph nodes, and bone.

Soft tissue sarcomas apparently arising in chronic tropical ulcers

Of 720 soft tissue sarcomas received from Malawi over a 15 year period, eight had apparently arisen in chronic tropical ulcers which are endemic in that part of Africa. These eight tumours were classified as leiomyosarcoma (three), extraskeletal osteosarcoma (two), malignant fibrous histiocytoma (one), myxoid liposarcoma (one) and unclassifiable (one). All had a history suggestive of malignant change in a long-standing ulcer, in each case clinically thought to be a squamous carcinoma. However, in none was there evidence of an epithelial origin and all were negative for epithelial membrane antigen and cytokeratin. This association has not previously been reported. The validity of this proposed association is discussed.

Primary extraosseous osteogenic sarcoma in the retroperitoneal space. A case report and review of the literature

One case of primary, extraosseous osteogenic sarcoma in the retroperitoneal region is presented, which is the tenth case hitherto reported in the literature. The 3 females and 7 males reported had a median age at diagnosis of 59 1/2 years. The tumours were all large at diagnosis and the symptoms short and uncharacteristic. There was no characteristic set of laboratory or roentgenologic findings; 2 of the 10 cases had elevation of alkaline phosphatase, and in 4 cases roentgen examination revealed tumour calcifications. The prognosis was poor and 8 of the 10 patients died, with a median survival of 9 1/2 months. In 3 cases, surgery was supplemented by chemotherapy without obvious improvement in survival.

Extraskeletal osteosarcoma arising in an ectopic hamartomatous thymus. Report of a case and review of the literature

A unique case of an osteosarcoma arising within a hamartoma of the thymic gland located in the left pleural cavity of an 11-year-old girl is described. The presence of abundant mature lamellar bone within this thymic hamartoma provides an explanation for the osseous histogenesis of the sarcoma. The development of an osteosarcoma from extraskeletal osseous tissue is a rare occurrence and has been documented in association with myositis ossificans and most recently in a case of dermatomyositis with metaplastic ossification.

Extraosseous osteogenic sarcoma. A review of 48 patients

The clinical records and histologic material of 48 patients with extraosseous osteogenic sarcoma were reviewed. Most patients developed their tumors in the fifth or sixth decades of life. Five patients (10%) developed neoplasms in an area of prior radiation therapy, a median of 15 years after their exposure. Six patients (13%) related a history of trauma to the area where their extraosseous osteogenic sarcoma developed. The course of most patients was that of multiple local recurrences (69%) followed by pulmonary metastases (80%) and death (76%). Amputation or wide resection followed by irradiation appeared to be the most effective types of therapy, with median survivals greater than 60 months for patients receiving these treatments, compared to 28 months for patients initially treated with resection alone. Chemotherapy was not effective for patients with advanced disease; however, adjuvant chemotherapy after surgery may have been of value. Four of five patients who received adjuvant chemotherapy after surgery are alive and disease-free; the only two survivors after development of pulmonary metastases received adjuvant chemotherapy after surgical resection of visible pulmonary metastases.

Extraskeletal Osteosarcoma. Case report and differential diagnosis

In this case of an extraskeletal osteosarcoma initially there were typical difficulties in diagnosing a) a malignant mesenchymal tumor and b) a bone-producing tumor. Only focally the test-booking findings of an osteosarcoma were present. The differential diagnosis concerned mainly pseudosarcomatous lesions with bone formations, which histologically may appear suspicious, however, follow a benign course clinically.