Primary osteogenic sarcoma arising from the dura mater: case report

Primary meningeal osteoblastic osteosarcoma containing fibroblast osteosarcoma: clinicopathological analysis and literature review

Primary meningeal osteosarcoma is rare. The aim of this report is to investigate the symptoms, imaging data, pathological diagnosis, and treatment of primary meningeal osteosarcoma. A 54-year-old male patient was admitted to hospital because of numbness and weakness in the right limb, accompanied by dizziness and chest tightness. The CT and MRI examination of the patient showed multiple irregular mixed density mass signal shadows. After preliminary examinations and tests, meningioma was considered. After surgical resection, the mass was sent for pathological examination, and primary meningeal osteosarcoma was finally diagnosed. The patient did not receive radiotherapy and chemotherapy and died 7 months later. Primary meningeal osteosarcoma is a rare and easily misdiagnosed disease. There is no test that is specific enough up to now, so the correct diagnosis can only be determined by a histopathological examination. At present, there are no clear drug, radiotherapy, and chemotherapy guidelines for the treatment of this disease in addition to surgery, and the prognosis is poor.

Radiation-induced meningeal osteosarcoma of tentorium cerebelli with intradural spinal metastases

BACKGROUND

Primary meningeal osteosarcomas and radiation-induced extraosseous tumors are extremely rare. We encountered a patient with a radiation-induced meningeal osteosarcoma with metastatic spread.

CASE DESCRIPTION

A 54-year-old man presented with a 2-week history of nausea, vomiting, and ataxia. CT and MRI studies revealed an extra-axial, dural-based mass in the posterior fossa arising from the tentorium cerebelli. The patient underwent complete resection of the tumor with adjuvant chemotherapy. Histopathologic analysis revealed chondroblastic osteosarcoma. Tumor recurrence was observed 9 months after initial diagnosis, and adjuvant radiation therapy was administered. The intracranial disease stabilized; however, multiple cervico-thoracic spinal metastases were discovered 15 months after initial diagnosis. The patient expired 16 months after initial diagnosis.

CONCLUSION

Meningeal osteosarcomas are rare lesions that can metastasize and should be considered in the differential diagnosis for dural-based lesions, especially in the case of previous radiation therapy.

Osteosarcoma presenting as hemorrhagic cerebellar metastasis

PURPOSE

Osteosarcoma is the most common malignant bone tumor in children and adolescents. Brain metastasis from osteosarcoma was once uncommon; however, with the advent of chemotherapeutic agents and improved imaging modalities, it has become a more common and recognized finding. Brain metastases are, rarely, the initial presenting symptom, but instead are a late and preterminal event in the disease process. When osteosarcomas manifest in the central nervous system, they tend to occur in the gray-white junction in the anterior circulation akin to other metastatic lesions in the brain.

CASE REPORT

The authors report a case of a 16-year-old boy who presented with acute neurological deterioration due to a posterior fossa hemorrhage and was subsequently found to have a primary site localizing to the metaphysis of the right femur with florid metastatic disease.

CONCLUSIONS

This is the first case reported in the literature in which an osteosarcoma initially presented as cerebral metastasis in the form of a posterior fossa hemorrhage with a rapidly deteriorating course.

Primary meningeal osteosarcoma of the brain during childhood. Case report

Primary meningeal osteosarcomas are rare tumors, with only 19 reported cases in the literature; only 4 of these, including the present case, are in pediatric patients. In this report, the authors present the case of an 8-year-old boy with a history of generalized tonic-clonic seizures who was found to harbor a meningeal osteosarcoma within the sylvian fissure. Initial working diagnoses included meningioma and glioma. After tumor enlargement and progressive symptoms, the patient underwent a large frontotemporal craniotomy and complete resection of the lesion, which recurred 6 and 12 months after the initial surgery and was surgically treated after each recurrence. The rarity of primary meningeal osteosarcomas can make their diagnosis difficult, and histopathological evaluation is mandatory for diagnosis. Because of their fast progression, they must be treated aggressively by means of surgery, chemotherapy, and radiotherapy.

Central causes of foot drop: rare and underappreciated differential diagnoses

BACKGROUND/OBJECTIVE

Peripheral causes of foot drop are well recognized. However, causes stemming from the central nervous system represent rare, important, and underappreciated differential etiologies.

METHODS

Two cases of foot drop stemming from central causes are described.

PATIENTS

The first patient, a 46-year-old man with a remote history of lumbar spine fracture and L4-L5 instrumentation/fusion, presented with progressive weakness and numbness of the left foot, followed within 3 months by similar symptoms in the right foot. Lumbar spine imaging failed to reveal compressive nerve root pathology. Electromyography, nerve conduction studies, and muscle and nerve biopsy suggested a preganglionic lesion and ruled out a peripheral cause. Upper spine magnetic resonance imaging (MRI) revealed significant spinal stenosis at C4-C7 and T11-T12. Patient 2 was a 66-year-old man with a known left parasagittal convex meningioma diagnosed 2 years prior presented with a progressive right foot drop over 2 months. Spine imaging was normal, and serial brain MRI confirmed a slowly enlarging parasagittal meningioma.

RESULTS

Following decompressive laminectomies at C4-C7 and T11-T12, patient 1's gait improved, with marked resolution of his right foot drop and significant improvement on the left. Patient 2 underwent craniotomy for microsurgical tumor resection. At the 2-week follow-up examination, he was taking daily walks.

CONCLUSIONS

Central causes, although rare, need to be considered in the differential diagnosis of foot drop. Central causative lesions usually occur at locations where pyramidal tract connections are condensed and specific and the function is somatotopically organized. These cases confirm that good results can be achieved when correctable central causes of foot drop are recognized.

Intracranial osteosarcoma after radiosurgery--case report

A 56-year-old woman presented with an intracranial osteosarcoma at the site of previous radiosurgery, manifesting as sudden onset of headache and left hemiparesis with aphasia. She had a previous history of stereotactic radiosurgery for an intracranial tumor under a diagnosis of falx meningioma. Computed tomography showed intratumoral and peritumoral hemorrhage at the right parietofrontal region. Gross total resection of the tumor with hematoma was performed. The histological diagnosis was osteosarcoma. Sarcomatous change is a rare complication of radiotherapy. This case illustrates that osteosarcoma may develop years after radiosurgery for benign brain neoplasm.