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Bacci G, Avella M, Picci P, Briccoli A, Dallari D, Campanacci M. Metastatic Patterns in Osteosarcoma. TUMORI JOURNAL 2018; 74:421-7. [PMID: 3055577 DOI: 10.1177/030089168807400408] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical courses of 193 patients with high-grade, non-metastatic osteosarcoma were reviewed to ascertain the evolution of the natural history of the disease. All patients had the primary lesion in the extremities and were treated at the Rizzoli Orthopaedic Institute between 1976 and 1982 with surgery alone (30 cases) or surgery plus adjuvant chemotherapy (163 cases). All patients were regularly followed at our Institute. One hundred and fourteen patients, of which 27 were treated with surgery alone and 87 treated with adjuvant chemotherapy, developed overt metastatic disease. No differences were found concerning the sites of the first relapse which, for approximately 90 % of cases, were lungs in both groups. However, in the group of patients treated with adjuvant chemotherapy the development of overt metastatic disease, as compared to non-adjuvant patients, was delayed with time (13 vs 8 months) and the number of metastatic nodules in the lung at first relapse was reduced. This alteration in metastatic pattern due to adjuvant chemotherapy is important because it allows surgical resection of pulmonary metastases in a larger number of patients (51 % vs 29 %).
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Affiliation(s)
- G Bacci
- Bone Tumor Center, Istituto Ortopedico Rizzoli, Bologna, Italia
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2
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Osteosarcoma Metastases With Direct Cardiac Invasion: A Case Report and Review of the Pediatric Literature. J Pediatr Hematol Oncol 2017; 39:188-193. [PMID: 28267087 DOI: 10.1097/mph.0000000000000808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Metastatic osteosarcoma with direct cardiac involvement is an exceptionally rare finding, with only 63 total reported cases in the English literature over the past 123 years. Although the precise incidence is unknown, we estimate that direct cardiac involvement currently occurs in <2% of metastatic osteosarcoma cases. We also find that before the adoption of adjuvant chemotherapy as a standard of care therapy for osteosarcoma, metastatic osteosarcoma to the heart was much more common than it is today, as cardiac involvement occurred in ∼20% of cases of metastatic osteosarcoma before the 1980s. This suggests that adjuvant chemotherapy has not only improved the overall prognosis of osteosarcoma, but also altered the metastatic pattern of disease. In this paper we present the case of an 11-year-old boy with metastatic osteosarcoma to the cardiac interventricular septum, as well as review 20 other previously reported pediatric cases of metastatic osteosarcoma to the heart. We also analyzed the cardiac surgical outcomes for 11 pediatric patients with metastatic osteosarcoma to the heart. The median disease-free survival time was 12 months, demonstrating that metastatic osteosarcoma to the heart is currently a rare occurrence with a poor prognosis.
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Verma V, Talmon GA, Zhen WK. Intracardiac Metastasis From Non-Small Cell Lung Cancer. Front Oncol 2015; 5:168. [PMID: 26258073 PMCID: PMC4508520 DOI: 10.3389/fonc.2015.00168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/08/2015] [Indexed: 12/15/2022] Open
Abstract
A 56-year-old female with history of stage IIA adenosquamous lung carcinoma treated 13 months prior to presentation with lobectomy, mediastinal lymph node dissection, and adjuvant chemotherapy, presented for several weeks of worsening dyspnea. Exam was non-focal aside from tachycardia. Computed tomography of the chest revealed a large 4 cm × 5 cm mass in the bilateral ventricular myocardium. There was also evidence of metastatic disease elsewhere in the body, including a supraclavicular lymph node that was positive for metastatic adenosquamous lung carcinoma. She started whole heart radiotherapy and was to commence chemotherapy but passed away. This report discusses important aspects of diagnosis of this not uncommon condition that many oncologists may come across. We also discuss differential diagnosis of an isolated intracardiac mass as first-diagnosis presentations, and discuss the great importance of multidisciplinary cardio-oncologic management and clinical prioritization.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center , Omaha, NE , USA
| | - Geoffrey A Talmon
- Department of Pathology, University of Nebraska Medical Center , Omaha, NE , USA
| | - Weining K Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center , Omaha, NE , USA
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Maleki M, Mozaffari K, Givtaj N, Tatina A, Bahadorian B. Metastatic osteosarcoma and heart: a rare involvement in an unusual cardiac location. HEART ASIA 2013; 5:120-1. [PMID: 27326101 DOI: 10.1136/heartasia-2013-010342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Majid Maleki
- Department of Echocardiography , Shahid Rajaei Cardiovascular Medical Center , Tehran , Iran
| | - Kambiz Mozaffari
- Department of Pathology , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences , Tehran , Iran
| | - Nader Givtaj
- Department of Surgery , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences, Tehran , Iran
| | - Alireza Tatina
- Department of Cardiology , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences , Tehran , Iran
| | - Behdad Bahadorian
- Department of Cardiology , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences , Tehran , Iran
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5
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Elasfar A, Khalifa A, Alghamdi A, Khalid R, Ibrahim M, Kashour T. Asymptomatic metastatic osteosarcoma to the right ventricle: Case report and review of the literature. J Saudi Heart Assoc 2012; 25:39-42. [PMID: 24174844 DOI: 10.1016/j.jsha.2012.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 03/17/2012] [Accepted: 05/23/2012] [Indexed: 11/26/2022] Open
Abstract
Metastatic cardiac tumors are far more common than primary tumors, and benign primary cardiac tumors are common than malignant tumors. We report a 22-year-old Saudi woman with right femur osteosarcoma who was found to have a large right ventricular mass by transthoracic and transesophageal echocardiography. Diagnosis was highly suggestive by cardiac magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan. We performed a review of the literature for metastatic osteosarcoma of the right ventricle.
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Oñoro G, Hernández C, Sirvent S, Aleo E, Molina B, Atienza AL, Pérez-Martínez A. Unusual sites of extrapulmonary metastases of osteosarcoma after several lines of treatment. Pediatr Hematol Oncol 2011; 28:604-8. [PMID: 21875323 DOI: 10.3109/08880018.2011.590958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors report a case of peritoneal and chest wall metastases in a 17-year-old boy previously diagnosed of femur osteosarcoma with metastases in the lung and bones. Although the patient achieved complete remission after initial treatment, he presented with lung metastasis 15 months after initial diagnosis. They were resected 3 times and he received second-line chemotherapy with gemcitabine and docetaxel. However, 31 months after initial diagnosis he presented with abdominal and chest wall masses. In this report the authors discuss clinical outcomes and how unusual sites of metastasis are being increasingly reported after the use of new treatments.
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Affiliation(s)
- Gonzalo Oñoro
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo 65, Madrid, Spain.
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7
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Cardiac metastasis of osteosarcoma. Open Med (Wars) 2010. [DOI: 10.2478/s11536-010-1018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractCardiac osteosarcoma metastasis is extremely rare and is documented in several case reports in the literature. The behaviour of osteosarcoma metastases is similar to the primary tumour. Thoracic non-enhanced computed tomography (CT) examination is beneficial in the detection of calcific cardiac metastases. In this case report, we describe a 29-year-old woman with cardiac osteosarcoma metastasis after 7 years of follow-up, compare the demographic features with previous cases and discuss the imaging findings.
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Abstract
There are several reports of osteosarcoma metastases to the heart. A rare case of a metastatic osteosarcoma to the endocardium of the left atrium in a 17 year old patient is described. The radiological features are discussed in detail.
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Affiliation(s)
- A Atra
- Department of Paediatric Oncology, Royal Marsden Hospital, Sutton, Surrey, UK
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James CL, Byard RW, Knight WB, Rice MS. Metastatic osteogenic sarcoma to the heart presenting as bacterial endocarditis. Pathology 1993; 25:190-2. [PMID: 8367202 DOI: 10.3109/00313029309084798] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A patient with metastatic osteogenic sarcoma involving the left atrium is described who presented with features of bacterial endocarditis. The source of infection was the adjacent esophagus into which the tumor had eroded. This case demonstrates that sarcomas metastasizing to the heart may result in a clinical condition indistinguishable from infective endocarditis. At post-mortem, careful dissection of cardiac metastases should be undertaken to check for possible esophageal involvement.
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Affiliation(s)
- C L James
- Department of Histopathology, Adelaide Children's Hospital, SA
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Limper AH, Prakash UB, Kokmen E, Callahan MJ. Cardiopulmonary metastatic lesions of osteosarcoma and associated cerebral infarction. Mayo Clin Proc 1988; 63:592-5. [PMID: 3163745 DOI: 10.1016/s0025-6196(12)64889-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Osteogenic sarcoma frequently disseminates by hematogenous routes. A 32-year-old patient underwent evaluation for an acute cerebral infarction. Cardiac auscultation disclosed an abnormal diastolic sound. Echocardiographic examination revealed a large left atrial mass, which was found at thoracotomy to be metastatic osteogenic sarcoma. Cerebral computed tomographic scans at the time of initial examination and 3 months later demonstrated new cerebral lesions consistent with metastatic growths. The abrupt cerebral infarction, other clinical findings, and results of diagnostic studies strongly suggested that the acute cerebrovascular event was the result of metastatic cerebral embolization from the tumor material found in the thorax. Cerebral infarction is an unusual and catastrophic complication of thoracic metastatic lesions of osteogenic sarcoma.
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Affiliation(s)
- A H Limper
- Division of Thoracic Diseases, Mayo Clinic, Rochester, MN 55905
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Abstract
Osteosarcoma is the most common bone tumor of children and adolescents. The peak incidence of the disease is in the 15 to 19 year age group. The disease is more commonly seen in males than females. While several factors, including exposure to radiation, genetic disorders such as retinoblastoma, and high rate of bone growth, have been associated with osteosarcoma, in most cases no definite etiology can be established. Osteosarcoma usually originates in the metaphyseal region of long bones and extends through the cortex, causing varying degrees of bone destruction and expansion of periosteum. The radiographic appearance caused by this process is often referred to as "sun burst" sign. Positive diagnosis of osteosarcoma is made by histopathology. The histopathological classification of osteosarcoma can also predict the degree of aggressive behavior of this tumor and thus has prognostic significance. Surgery, including amputation or limb-salvage procedure, is the mainstay of treatment of osteosarcoma. It is now unequivocally established that adjuvant chemotherapy will prolong the survival of patients with this disease. Chemotherapy agents often used include platinum derivates, methotrexate, vincristine, cyclophosphamide, adriamycin, actinomycin D, bleomycin and DTIC. Depending on surgical decision, these agents can be used prior to or after the operation. Immediate fitting with prosthesis and provision of appropriate medical and psychological support in the care of these patients is essential.
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Affiliation(s)
- C K Tebbi
- Department of Pediatrics, Roswell Park Memorial Institute, Buffalo, New York 14263
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Tominaga K, Shinkai T, Eguchi K, Saijo N, Sasaki Y, Beppu Y, Nishikawa K. The value of two-dimensional echocardiography in detecting malignant tumors in the heart. Cancer 1986; 58:1641-7. [PMID: 3463393 DOI: 10.1002/1097-0142(19861015)58:8<1641::aid-cncr2820580811>3.0.co;2-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Six unusual cases of tumor involvement of the heart and pericardium, diagnosed antemortem by two-dimensional echocardiography (2DE), are described. The tumors consisted one each of sacral chordoma, mediastinal seminoma, leiomyosarcoma of the uterus, osteosarcoma, invasive thymoma, and lung cancer. The current study again recognizes the concept that any type of malignant tumor has a possibility of involving the heart. If cardiac involvement is suspected, 2DE examination should be performed in patients with any kind of malignant tumor. The information obtained not only provides guidance for therapeutic maneuvers, but also is beneficial for follow-up observation of the patients and assessment of the therapy.
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Takaue Y, Slopis JM, Anzai T, Robertson R, Jaffe N. Successful treatment of pulmonary and abdominal metastatic osteosarcoma. MEDICAL AND PEDIATRIC ONCOLOGY 1985; 13:126-8. [PMID: 3857430 DOI: 10.1002/mpo.2950130304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A patient with telangiectatic osteosarcoma of the proximal fibula while receiving adjuvant chemotherapy, developed pulmonary and, later, mesenteric metastases. The pulmonary metastases were resected and the mesenteric metastasis was eradicated with surgery and intra-arterial cis-diamminedichloroplatinum II. This represents an additional example of an alteration in the clinical pattern of metastases induced by chemotherapy and the ability to achieve cure with a multidisciplinary approach.
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