Immunohistochemical study of bone GLA protein in primary bone tumors

Soft tissue telangiectatic osteosarcoma in a young patient: imaging and immunostains

Telangiectatic osteosarcoma of the soft tissue is rare and generally affects adults older than 50 years of age. We present the case of a 17-year-old male who developed a mass in the right thigh. The CT and MRI findings suggested a malignant hemorrhagic tumor without discernable osteoid matrix. Differential diagnosis included various hemorrhagic mesenchymal tumors. Histology revealed large multiple cysts lined with septae and filled with numerous giant cells, pleomorphic spindle cells, and occasionally an osteoid-like substance. Immunostaining for osteocalcin was positive in the cytoplasm of both stromal mononucleate and multinucleate giant cells. Surgery and adjuvant chemotherapy were applied and the patient survives to the time of writing after 30 months of follow-up without recurrence or metastasis.

Submicroscopic and immunohistochemical profile of surface osteosarcomas

While the analysis of the clinical, radiologic, and histopathologic features of surface osteosarcomas has been the subject of several papers, identification of the phenotypic features of these tumors has so far received little attention. The aim of the present study was to characterize the neoplastic cells of surface osteosarcomas using an ultrastructural and immunohistochemical approach. Glutaraldehyde-fixed, epoxy resin-embedded archival pieces of tissue from 8 surface osteosarcomas (4 parosteal low-grade osteosarcomas, 3 dedifferentiated parosteal osteosarcomas, 1 periosteal osteosarcoma) were investigated using transmission electron microscopy. Sections of formalin-fixed, paraffin-embedded tumor specimens were employed for the immunohistochemical analysis of osteonectin and osteocalcin, two markers of cells of osteoblastic lineage, and sigma-smooth muscle actin and muscle specific actin. By electron microscopy, the tumors were composed of a mixture of neoplastic cells with varied differentiation, i.e., osteoblast-like, fibroblast-like, myofibroblast-like, and chondroblast-like. The latter were particularly abundant in the periosteal osteosarcoma. Osteocalcin expression was detected in the cytoplasm of neoplastic cells in 6 cases (66.6%), while osteonectin was expressed at least focally in all cases. The expression of the noncollagenous bone proteins was higher in low-grade osteosarcomas than in dedifferentiated osteosarcomas. sigma-Smooth muscle actin and muscle-specific actin expression were detected in 4 (44.4%) and 5 (55.5%) cases respectively, and the distribution was similar in both low-grade and dedifferentiated lesions. The results do not confirm previous observations regarding the prevalence of a specific cellular phenotype in surface osteosarcomas. Further, the myofibroblast-like cells that are present in variable numbers in these tumors are probably modified osteoblasts, since they co-express actin, osteonectin, and osteocalcin.

Phalangeal intraosseous well-differentiated osteosarcoma of the hand

A case of intraosseous well-differentiated osteosarcoma in one phalanx of the hand is reported. A 78-year-old man noticed swelling in the little finger of his right hand approximately 7 years before referral. Imaging disclosed a tumour with a "ground glass" appearance and irregular mottled calcification occupying almost all of the phalanx marrow and suggested slight invasion into the soft tissue. Open biopsy suggested a diagnosis of well-differentiated fibroblastic osteosarcoma. The finger and its metacarpal bone were amputated and a tumour measuring 3.5 x 2.2 x 2.0 cm and with an indistinct soft tissue margin was found in the bone marrow. Histologically, the tumour was composed of fibroblastic cells with few mitoses, and neoplastic bone formation was apparent. Although the tumour appeared to be a fibrous dysplasia, the presence of nuclear atypia, hypercellularity, and the absence of a typical woven bone pattern in addition to the soft tissue invasion indicated otherwise. Ultrastructural examination showed focal myofibroblastic differentiation, and immunohistochemistry revealed smooth muscle actin, vimentin, osteocalcin, osteonectin and MIBI in the tumour cells. This ultrastructural and immunohistochemical study is believed to be the first detailed report of an intraosseous well-differentiated osteosarcoma of phalangeal bone.