Nuclear imaging of an extraskeletal retroperitoneal osteosarcoma: respective contribution of 18FDG-PET and (99m)Tc oxidronate (2005:1b)

99mTc-MDP Bone Scan and 18F-FDG PET/CT Imaging of Primary Hepatic Osteosarcoma

A 65-year-old man presented with abdominal bloating, pain, and nausea for 5 days. Abdominal CT revealed a heterogeneous mass with a large area of calcification, and rupture of the mass was seen around the capsulafibrosa. According to pathological examination after percutaneous puncture biopsy, the histopahological and immunohistochemical findings were suggestive of metastatic or primary hepatic osteosarcoma. Whole body bone scintigraphy demonstrated elevated 99mTc-MDP activity in hepatic mass, but no skeletal lesions. The diagnosis of primary hepatic osteosarcoma was finally confirmed. PET/CT showed hepatic mass with heterogeneous high-uptake, and multiple metastases in portacaval lymph nodes, lungs and the third thoracic vertebra were considered.

Relapsed primary extraskeletal osteosarcoma of liver: A case report and review of literature

BACKGROUND

Extraskeletal osteosarcoma (ESOS) is a highly malignant osteosarcoma that occurs in extraskeletal tissues. It often affects the soft tissues of the limbs. ESOS is classified as primary or secondary. Here, we report a case of primary hepatic osteosarcoma in a 76-year-old male patient, which is very rare.

CASE SUMMARY

Here, we report a case of primary hepatic osteosarcoma in a 76-year-old male patient. The patient had a giant cystic-solid mass in the right hepatic lobe that was evident on ultrasound and computed tomography. Postoperative pathology and immunohistochemistry of the mass, which was surgically removed, suggested fibroblastic osteosarcoma. Hepatic osteosarcoma reoccurred 48 d after surgery, resulting in significant compression and narrowing of the hepatic segment of the inferior vena cava. Consequently, the patient underwent stent implantation in the inferior vena cava and transcatheter arterial chemoembolization. Unfortunately, the patient died of multiple organ failure postoperatively.

CONCLUSION

ESOS is a rare mesenchymal tumor with a short course and a high likelihood of metastasis and recurrence. The combination of surgical resection and chemotherapy may be the best treatment.

Bisphosphonates, Old Friends of Bones and New Trends in Clinics

Bisphosphonates, used for a long time in osteoporosis management, are currently the target of intensive research, from pre-formulation studies to more advanced stages of clinical practice. This review presents an overview of the contributions of this family of compounds to human health, starting with the chemistry and clinical uses of bisphosphonates. Following this, their pharmacology is described, highlighting administration-borne handicaps and undesirable effects. The last three sections of the review describe the research efforts that seek to curb delivery-related issues and expand bisphosphonate use. Innovative routes and strategies of administration, such as nano-encapsulation for oral intake or injectable cements for local or in-bone delivery are presented, as well as the latest results of case studies or preclinical studies proposing new therapeutic indications for the clinically approved bisphosphonates. Finally, a selection of anti-infectious bisphosphonate new drug candidates is shown, with focus on the molecules reported in the last two decades.

Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 2-Uncommon Sarcomas

Soft-tissue sarcomas occurring in the abdomen and pelvis are an uncommon but important group of malignancies. Recent changes to the World Health Organization classification of soft-tissue tumors include the movement of gastrointestinal stromal tumors (GISTs) into the soft-tissue tumor classification. GIST is the most common intraperitoneal sarcoma. Liposarcoma is the most common retroperitoneal sarcoma, and leiomyosarcoma is the second most common. GIST, liposarcoma, and leiomyosarcoma account for the majority of sarcomas encountered in the abdomen and pelvis and are discussed in part 1 of this article. Undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma), dermatofibrosarcoma protuberans, solitary fibrous tumor, malignant peripheral nerve sheath tumor, rhabdomyosarcoma, extraskeletal chondro-osseous sarcomas, vascular sarcomas, and sarcomas of uncertain differentiation uncommonly arise in the abdomen and pelvis and the abdominal wall. Although these lesions are rare sarcomas and their imaging features overlap, familiarity with the locations where they occur and their imaging features is important so they can be diagnosed accurately. The anatomic location and clinical history are important factors in the differential diagnosis of these lesions because metastasis, more-common sarcomas, borderline fibroblastic proliferations (such as desmoid tumors), and endometriosis have imaging findings that overlap with those of these uncommon sarcomas. In this article, the clinical, pathologic, and imaging findings of uncommon soft-tissue sarcomas of the abdomen and pelvis and the abdominal wall are reviewed, with an emphasis on their differential diagnosis.

Extraosseous Osteosarcoma of the Liver Demonstrated on 18F-FDG PET/CT Imaging

A 66-year-old woman presented with abdominal pain for 1 month. Ultrasonography displayed multiple hepatic masses that were thought as metastases. FDG PET/CT was performed to assess the nature of these masses and to search primary malignancy. The images showed elevated FDG activity in the partially calcified hypodense lesions in the liver without abnormality elsewhere. The lesions were subsequently confirmed as primary extraosseous osteosarcoma in the liver. The patient received liver transplantation. Six months later, her CA-125 was significantly increased. The follow-up PET/CT scan demonstrated the widespread metastases.

Gastric wall implantation metastasis of retroperitoneal extraskeletal osteosarcoma: A case report and review of the literature

Retroperitoneal extraskeletal osteosarcoma (ESOS) is a rare and highly invasive tumor that is usually diagnosed at an advanced stage due to the insidious onset. The present study analyses a case of retroperitoneal ESOS and its clinical, radiological and therapeutic conditions, and also provides a review of the literature. A 52-year-old male was diagnosed with retroperitoneal ESOS. The patient succumbed to the condition one year after the initial surgery. During treatment, the patient underwent two additional surgeries and two courses of chemotherapy. In the present case, a peritoneal metastatic lesion of ESOS was shed from the peritoneum and implanted into the outer membrane of the stomach and metastasis was identified, this has rarely been reported in the literature. Retroperitoneal ESOS should be considered in the differential diagnosis of a retroperitoneal mass in order to facilitate the management of surgery and help determine the appropriate treatment of the disease.

SPECT/CT imaging of retroperitoneal extraskeletal osteosarcoma

The condition of a 52-year-old man was diagnosed with unresectable retroperitoneal extraskeletal osteosarcoma. SPECT/CT demonstrated a retroperitoneal extraskeletal osteosarcoma adjacent to the right upper ureter with large calcifications and increased Tc-MDP accumulation. Multiple hepatic capsular, renal fascial, and peritoneal metastases were noted. Four months later, multiple peritoneal metastases were noted at the second-look surgery. A histopathologic examination confirmed osteosarcoma.

Primary extraskeletal osteosarcoma of the seminal vesicle: a case report and literature review

A primary extraskeletal osteosarcoma (EOS) is a rare tumour. An EOS of the seminal vesicle has not been reported in the literature. We describe a case of a seminal vesicle EOS initially detected as a pre-rectal mass on a routine transrectal ultrasound in a 48-year-old man. A computed tomography (CT) scan confirmed the tumour to be arising from the left seminal vesicle. A robot-assisted laparoscopic seminal vesiculectomy was performed to avoid neurovascular bundle injury. Microscopic examination of the resected specimen showed a poorly differentiated osteosarcoma originating from the seminal vesicle. The patient received adjuvant chemotherapy. He is doing well without voiding or erectile dysfunction and he is tumour-free five months after surgery.