1
|
Setiawati R, Lay ES, Testini V, Rahardjo P, Edward M, Mustokoweni S, Guglielmi G. Advance MR evaluation of synchronous multifocal osteosarcoma with pathologic fracture. BJR Case Rep 2021; 7:20210015. [PMID: 35047204 PMCID: PMC8749407 DOI: 10.1259/bjrcr.20210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: Synchronous multifocal osteosarcoma is a rare condition in which the osteosarcoma presents with multiple bone lesions at the time of diagnosis, usually without any visceral metastases. The first case was described in early 1930s by Silverman. To report a case of synchronous multifocal osteosarcoma in adolescent with pathologic fracture. Methods: An 18-year-old girl presented with a painful mass in the right thigh of 4 months’ duration and a history of thigh bone fracture a month ago. Patient’s medical records and family history was unremarkable. Physical examination showed angulation and shortening at right femoral region with tenderness and swelling. Initial radiograph and magnetic resonance (MR) images showed multiple lesions in right femoral shaft and pelvic bone with primary tumor in right distal femur with pathologic fracture and multiple bone marrow lesions found in the contralateral bones. Imaging and histopathological results supported the diagnosis of synchronous multifocal osteosarcoma. After following the chemotherapy as the treatment of choice, the radiograph and MRI evaluation were done and showed reduction of the mass size with union of the destructed part with the formation of callus. The advance MRI revealed reduction of the overall mass and the composition of the viable area compared to previous study. The patient had satisfying response to chemotherapy series and a better functional outcome on subsequent visits. Results: Diagnosis of synchronous multifocal osteosarcoma was based on patient and family history and finding of multiple lesions in the MR images, meanwhile the plain radiograph only revealed the primary tumor. Amstutz described multifocal osteosarcoma as presence of one primary tumor and several smaller lesions. Most recent reviews concluded that multifocal osteosarcoma is bone-to-bone metastatic process rather than multicentric origin. The limitation in this case was absence of thoracic CT which is suggested to rule out any pulmonary metastases instead of routine chest radiograph. Conclusion: Although satisfying improvement was clinically achieved, further advanced MRI would be indicated to evaluate the progression of tumor and its respond to therapy.
Collapse
Affiliation(s)
- Rosy Setiawati
- Department of Radiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Eveline Stephanie Lay
- Department of Radiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Valentina Testini
- Department of Radiology, Barletta University Campus UNIFG, Barletta, Italy
| | - Paulus Rahardjo
- Department of Radiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Mouli Edward
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Sjahjenny Mustokoweni
- Department of Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | |
Collapse
|
2
|
KURTUL N, YURTTUTAN N, BAHAR AY, AKTAŞ G. Kalvaryumda multifokal osteosarkom: Nadir bir vaka sunumu ve literatür derlemesi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2019. [DOI: 10.17517/ksutfd.540305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
3
|
Buzzoni R, Della Torre S, Cortinovis D, Catena L. Case Report of Synchronous Multicentric Osteosarcoma and Review of the Literature: The Importance of Autopsy for Diagnosis. TUMORI JOURNAL 2019; 91:90-2. [PMID: 15850014 DOI: 10.1177/030089160509100119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Synchronous multicentric osteosarcoma is a rare entity with fewer than 100 well documented cases in the medical literature. The disease usually progresses rapidly in young patients and slightly slower in adults. We present a case of synchronous multicentric osteosarcoma with some peculiarities in a 73-year-old woman. The diagnosis was made after postmortem examination, which underlines the importance of this procedure. This case report is accompanied by a review of the literature.
Collapse
Affiliation(s)
- Roberto Buzzoni
- Medical Oncology Unit B. Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
| | | | | | | |
Collapse
|
4
|
Zhang HQ, Li MH, Gao P, Lan PH, Fan B, Xiao X, Lu YJ, Chen GJ, Wang Z. Preliminary Application of Precision Genomic Medicine Detecting Gene Variation in Patients with Multifocal Osteosarcoma. Orthop Surg 2017; 8:129-38. [PMID: 27384721 DOI: 10.1111/os.12249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The purpose of this study was to present our clinical experience of treating multifocal osteosarcoma (MFOS) in our center and gain more insight into the biology of this rare condition; in particular, to address with the help of precision genomic medicine the issue of whether the multiple osteosarcoma (OS) lesions in such patients are multi-centric or originate from one primary lesion and metastasize to other sites. Finally, we aimed to identify particular gene phenotypes and mutations that differentiate MFOS from OS with only one tumor. METHODS Clinical data of patients with MFOS treated at our center between June 2007 and October 2014 were collected and analyzed retrospectively. High throughput sequencing of the whole exome of normal tissue and multiple lesions had been performed on samples from two patients (HJF and JZ) diagnosed in 2014. To explore the particular gene phenotype and clinical significance of MFOS, these sequencing results were analyzed and compared with those from patients with osteosarcoma in a single site. Seven patients with MFOS (three male and four female; average age 19.71 ± 3.35 years were enrolled in this study. Two of these patients declined treatment and died after 4 and 6 months, respectively. The remaining patients received standard treatment comprising neoadjuvant chemotherapy, surgery and chemotherapy. The chemotherapy regimen was lobaplatin (45 mg/m(2) ), doxorubicin (60 mg/m(2) ) and ifosfamide (12 g/m(2) ). Patients were followed up every 3 months after completing treatment and evaluated by the Enneking and Response Evaluation Criteria in Solid Tumors scoring systems. RESULTS Up to the last follow-up on 1 December 2015, three patients were still alive. The event-free survival ranged from 4 to 144 weeks (median, 50.14 weeks), the mean (±SD) being 55.45 ± 45.47 weeks. Overall survival ranged from 16 to 388 weeks (median, 89 weeks; mean ± SD, 118.7 ± 147.7 weeks). The rates of mutation of the targeted drug-related genes were 133.5% ± 3.0% in the proximal tibia lesion and 113.1% ± 1.9% in the distal femur of patient HJF (P < 0.01) and 136.1% ± 10.8% in the proximal tibial lesion and 122.3% ± 5.5% in the proximal humerus of patient JZ (P = 0.0335). Furthermore, there were several anti-oncogenes in the somatic copy number variation lists analyzed from the two patients, especially TP53. However, no kataegis was found. CONCLUSIONS Early and radical surgery accompanied by appropriate chemotherapy is the optimal means of treating MFOS. These patients may benefit from precision genomic medicine.
Collapse
Affiliation(s)
- Hao-Qiang Zhang
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Ming-Hui Li
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Peng Gao
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Ping-Heng Lan
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Bo Fan
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Xin Xiao
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Ya-Jie Lu
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Guo-Jing Chen
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Zhen Wang
- Department of Orthopaedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| |
Collapse
|
5
|
Chen JY, Kesavan, Sathiyamoorthy S, Tan MH. Atypical Presentation of High-Grade Intramedullary Osteosarcoma with Bilateral Cervical, Supraclavicular, and Axillary Lymphadenopathy: A Case Report and Literature Review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Osteosarcoma typically presents with primary site pain. The authors report a case of extensive metastatic osteosarcoma without any complaint of primary site pain during initial presentation. The 23-year-old female patient presented with simultaneous multiple cervical, supraclavicular, and axillary lymphadenopathy, as well as two large subcutaneous fat tumours. Despite initial excision biopsy of cervical lymph nodes, the diagnosis of osteosarcoma was only clinched after open biopsy of the right distal femur lesions and further histological evaluation. Though the patient was promptly started on neo-adjuvant chemotherapy and achieved excellent histological response to treatment, the disease had relapsed quickly and she succumbed to the disease one year after initial presentation. This report highlights the need to be vigilant in the workup and investigation of osteosarcoma, as the presenting symptoms may be more heterogenous than the conventional teaching of primary site pain.
Collapse
Affiliation(s)
| | - Kesavan
- Department of Pathology, Singapore General Hospital, Singapore
| | | | - Mann Hong Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
6
|
Maheshwari AV, Jelinek JS, Seibel NL, Meloni-Ehrig AM, Kumar D, Henshaw RM. Bilateral synchronous tibial periosteal osteosarcoma with familial incidence. Skeletal Radiol 2012; 41:1005-9. [PMID: 22349598 DOI: 10.1007/s00256-012-1376-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 01/23/2012] [Accepted: 01/29/2012] [Indexed: 02/02/2023]
Abstract
Multifocal or multicentric osteosarcoma (OS) has been described as tumor occurrence at two or more sites in a patient without visceral metastasis. These may be synchronous (more than one lesion at presentation) or metachronous (new tumor developing after the initial treatment). The incidence of multifocal OS has ranged from 1.5 to 5.4% in large series, with the synchronous type being rarer. Similarly, periosteal OS is another rare subtype of surface OS and constitutes less than 2% of all OS. An 11-year-old female was diagnosed with bilateral synchronous tibial periosteal OS, which were confirmed by CT-guided biopsies. After neoadjuvant chemotherapy, the patient underwent a staged wide local resection of the tumors. The defect was reconstructed with a proximal tibial replacement on the left side and autologous bone grafting on the right side. The patient did well after surgery and is free of disease at 5.5 years of follow-up. However, her brother also developed a right tibial periosteal osteosarcoma 4 years after her index surgery. Genetic analysis of blood sample from both patients showed a similar missense mutation in at least one allele of TP53 gene (exon 8). To the best of our knowledge, a case of bilateral 'synchronous' periosteal OS with a familial incidence has not been reported before.
Collapse
Affiliation(s)
- Aditya V Maheshwari
- Department of Orthopaedics, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
| | | | | | | | | | | |
Collapse
|
7
|
Currall VA, Dixon JH. Synchronous multifocal osteosarcoma: case report and literature review. Sarcoma 2011; 2006:53901. [PMID: 17251658 PMCID: PMC1698141 DOI: 10.1155/srcm/2006/53901] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 07/12/2006] [Indexed: 11/17/2022] Open
Abstract
Background. Multifocal osteosarcoma is usually described as the occurrence of the tumour at two or more sites in a patient without pulmonary metastases and may be synchronous or metachronous. Case report. A previously well 21-year old male, who presented with a swollen, painful right knee with no history of trauma, was found to have a high-grade osteosarcoma of the distal tibia and proximal femur. He underwent resection and prosthetic replacement of the distal femur and proximal tibia and remains well 19 months after diagnosis. Discussion. Multifocal osteosarcoma is a rare condition with a poor prognosis. There is debate about whether it represents multiple primary tumours or metastatic disease.
Collapse
Affiliation(s)
- Verity A. Currall
- Department of Orthopaedics, Bristol Royal Infirmary, United Bristol Healthcare NHS Trust, Bristol BS1 3NU, UK
- *Verity A. Currall:
| | - John H. Dixon
- Avon Orthopaedics Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS16 1JE, UK
- Department of Orthopaedics, Weston General Hospital, Weston-Super-Mare, North Somerset, BS23 4TQ, UK
| |
Collapse
|
8
|
SATO H, HAYASHI N, YAMAMOTO H, NAGAI S, OHMORI K, KANAMORI M, ENDO S. Synchronous Multifocal Osteosarcoma Involving the Skull Presenting With Intracranial Hemorrhage -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:407-9. [DOI: 10.2176/nmc.50.407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hikari SATO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Nakamasa HAYASHI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | | | - Shoichi NAGAI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Kazuo OHMORI
- Department of Orthopedics, Faculty of Medicine, University of Toyama
| | - Masahiko KANAMORI
- Department of Orthopedics, Faculty of Medicine, University of Toyama
| | - Shunro ENDO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| |
Collapse
|
9
|
Behere R, Lele S. Synchronous osteosarcoma of mandible. ACTA ACUST UNITED AC 2009; 107:e45-9. [PMID: 19426906 DOI: 10.1016/j.tripleo.2009.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 01/20/2009] [Indexed: 11/16/2022]
Abstract
Osteosarcoma is the most common primary malignant bone tumor, but only 5% of lesions occur in the jaws. The incidence of synchronous osteosarcomas (1% to 3%) is even less. A combination of synchronous osteosarcoma, with one of the lesions occurring in the jaws, is a very rare combination. A case of synchronous osteosarcoma with involvement of the mandible in a 16-year-old girl is reported. In addition to the mandible, lesions were identified in the left femur, sixth thoracic vertebra, and possibly in the lungs. Imaging and histopathological features are described.
Collapse
Affiliation(s)
- Rohit Behere
- Oral Medicine and Radiology, Bharati Vidyapeeth University Dental College and Hospital, Pune, India.
| | | |
Collapse
|
10
|
Multifocal osteosarcoma in childhood. Musculoskelet Surg 2009; 93:27-31. [PMID: 19711159 DOI: 10.1007/s12306-009-0015-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 02/16/2009] [Indexed: 10/20/2022]
Abstract
Osteosarcoma is one of the most common primary malignant bone tumours in childhood, mainly affecting the metaphysis of long extremity bones. In rare cases, patients present at time of diagnosis with multiple bone lesions, sometimes in the absence of pulmonary metastases. The pathology pattern of these multifocal osteosarcomas occurring with a rare incidence of 0.5-4% is not yet clear, and in spite of investigations in diagnosis and therapy, the prognosis is still poor. We report two cases of multifocal synchronous osteosarcoma. The age of both children at the time of tumour detection was 14 years. A synchronous or metachronous occurrence of multiple bone lesions, initially in the absence of pulmonary metastases was seen. In both cases, treatment consisted of neoadjuvant chemotherapy, oncologic surgery and adjuvant chemotherapy. Tumour response to chemotherapy was good in one patient, and poor in the other case. In both patients initial R0-resection of the tumours was performed. The disease-free time was 1 year before detection of pulmonary metastases or relapse. By the combination of chemotherapy and aggressive surgery the prognosis in multifocal osteosarcoma has been improved over the last years. Nevertheless, the survival time is still short and seems to be correlated with the initial histological tumour response to chemotherapy.
Collapse
|
11
|
Imaging assessment of osteosarcoma in childhood and adolescence: diagnosis, staging, and evaluating response to chemotherapy. Cancer Treat Res 2009; 152:33-62. [PMID: 20213385 DOI: 10.1007/978-1-4419-0284-9_3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteosarcoma is an aggressive tumor of mesenchymal origin, capable of producing osteoid and immature bone. It is the most frequent primary malignant skeletal neoplasm in children and adolescents. Imaging studies play a major role in initial diagnosis, staging, and assessment of tumor response to chemotherapy. Conventional radiography is the prime imaging modality for diagnosis of bony tumors. Radionuclide bone scan is used in detection of metastatic lesions in the other bones. Computed tomography may be used as an adjunct to conventional radiography, but its main role is detection of pulmonary metastasis. The standard magnetic resonance imaging is the most specific modality for local staging and monitoring response to chemotherapy, and distinguishing postsurgical changes from residual tumor. Dynamic contrast-enhanced magnetic resonance imaging has been introduced to quantify the percentage of tumor necrosis, identify early responders, and thus predict survival. The role of 18F fluorodeoxyglucose positron emission tomography (PET) in the staging and management of osteosarcoma is evolving. It has the advantage of total body imaging and may have an overall role in tumor staging and grading, detection of early response, and therefore, in the prognosis and detection of recurrence.
Collapse
|
12
|
Arkader A, Huvos AG, Healey JH. Multifocal synchronous low-grade intramedullary and juxtacortical osteogenic sarcoma. Clin Orthop Relat Res 2007; 465:265-70. [PMID: 17906589 DOI: 10.1097/blo.0b013e318159a2e6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report the case of a 41-year-old woman who presented with ipsilateral synchronous low-grade juxtacortical osteogenic sarcoma of the distal femur and low-grade intramedullary osteogenic sarcoma of the proximal tibia. The diagnosis and treatment and a review of the literature also are provided.
Collapse
Affiliation(s)
- Alexandre Arkader
- Orthopedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | |
Collapse
|
13
|
Affiliation(s)
- Catherine Lerner
- Department of Radiology, Duke University, Durham, NC 27710, USA.
| | | |
Collapse
|
14
|
Suresh S, Saifuddin A. Radiological appearances of appendicular osteosarcoma: a comprehensive pictorial review. Clin Radiol 2007; 62:314-23. [PMID: 17331824 DOI: 10.1016/j.crad.2006.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 10/31/2006] [Accepted: 11/08/2006] [Indexed: 11/23/2022]
Abstract
Osteosarcoma is the most common primary malignant tumour of bone in adolescents and young adults. Hence, a comprehensive knowledge of the common and unusual imaging appearance of this tumour is essential. Correct diagnosis of the various varieties of osteosarcoma is important for optimal clinical management including staging, biopsy, treatment and follow-up of patients. This review article provides a comprehensive approach to the radiological diagnosis of the different types of appendicular osteosarcoma and illustrates the role of CT and MRI in further characterisation.
Collapse
Affiliation(s)
- S Suresh
- Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
| | | |
Collapse
|
15
|
Bacci G, Fabbri N, Balladelli A, Forni C, Palmerini E, Picci P. Treatment and prognosis for synchronous multifocal osteosarcoma in 42 patients. ACTA ACUST UNITED AC 2006; 88:1071-5. [PMID: 16877608 DOI: 10.1302/0301-620x.88b8.17809] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Between 1986 and 2002, 42 patients with synchronous multifocal osteosarcoma were treated with two different protocols of neoadjuvant chemotherapy. When feasible, the primary and secondary tumours were excised as a combined procedure. After initial chemotherapy 26 patients were excluded from simultaneous excision of all their secondary bone lesions as their disease was too advanced. In 12 patients only isolated excision of the primary lesion was possible. For 16 patients simultaneous operations were conducted to excise the primary and secondary lesions. This involved two supplementary sites in 15 patients and four additional sites in one patient. Of these, 15 attained remission but 12 relapsed and died (11 within two years). Three patients remained disease-free at five, six and 17 years. The histological response to pre-operative chemotherapy of the primary and secondary lesions was concordant in 13 of the 16 patients who underwent simultaneous operations at more than one site. The prognosis for synchronous multifocal osteosarcoma remains poor despite combined chemotherapy and surgery. The homogeneous histological responses in a large proportion of the primary and secondary lesions implies that synchronous multifocal osteosarcoma tumours are not multicentric in origin, but probably represent bone-to-bone metastases from a single tumour.
Collapse
Affiliation(s)
- G Bacci
- Department of Musculoskeletal Oncology, Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Lee HJ, Kim IO, Kim WS, Cheon JE, Kim KW, Yeon KM. Metachronous multifocal osteosarcoma: a case report and literature review. Clin Imaging 2002; 26:63-8. [PMID: 11814757 DOI: 10.1016/s0899-7071(01)00354-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Metachronous multifocal osteosarcoma (MFOS) is a rare form of osteosarcoma manifested by one or more new tumors developing after the initial treatment of primary osteosarcoma. The pathogenesis of metachronous MFOS is still obscure whether it represents multiple true primaries or metastatic disease. However, there is a clinical significance that metachronous MFOS is a potentially curable disease [Resnick D, Kyriacos M, Greenway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Resnick D, editor. Diagnosis of bone and joint disorders. Philadelphia: Saunders, 1995: p. 3697-9.]. To our knowledge, there have been only a few reports about metachronous MFOS. We report a case of MFOS in a 14-year-old boy with review of the literature.
Collapse
Affiliation(s)
- Hyun Ju Lee
- Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
STUDY DESIGN A case of multicentric osteosarcoma presenting with sacral radiculopathy is reported. OBJECTIVE To present unusual clinical and radiologic findings of multicentric osteosarcoma. SUMMARY OF BACKGROUND DATA Multicentric osteosarcoma is a rare variant of osteosarcoma. To the authors' knowledge, no cases of multicentric osteosarcoma presenting as sacral radiculopathy have been reported previously. METHODS A 14-year-old boy had a large sacral tumor extending into the spinal canal, which was found to account for the initial symptoms, which mimicked those of herniated nucleus pulposus. At diagnosis, a bone survey showed multiple foci of osteosarcoma in the long bones. RESULTS The patient was treated with chemotherapy, but died of the disease 8 months after the initial presentation. CONCLUSION Multicentric osteosarcoma should be considered in the differential diagnosis for a pediatric patient with low back pain and sciatica.
Collapse
Affiliation(s)
- T Yamamoto
- Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
| | | | | | | |
Collapse
|
19
|
Abstract
We report a typical case of multicentric synchronous osteosarcoma. An 8-year-old girl was referred to us. At diagnosis she had a dominant bone lesion in the left proximal tibia and other lesions in the pelvis, thoracic spine, right femoral shaft, and left lower limb, without any lung lesions. We administered high doses of cisplatin and doxorubicin hydrochloride, but they were not effective. A pulmonary metastatic lesion was first detected by chest X-ray 4 months after the diagnosis, and she died of pulmonary insufficiency within 1 year after the first presentation.
Collapse
Affiliation(s)
- K Sasaki
- Department of Orthopaedic Surgery, Sendai Self-Defense Force Hospital, 1-1 Minaminometate, Miyagino-ku, Sendai, Miyagi 983-8580, Japan
| | | | | |
Collapse
|
20
|
Zafad S, Madani A, Harif M, Quessar A, Trachli A, Benchekroun S. [Multifocal osteosarcoma. A case report]. Arch Pediatr 2000; 7:1077-80. [PMID: 11075263 DOI: 10.1016/s0929-693x(00)00316-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Multifocal osteosarcoma is an uncommon and aggressive presentation of osteosarcoma. CASE REPORT We report a case of multifocal osteosarcoma in a 12-year-old boy who was admitted for a tumor of the skull, associated with pleural and pulmonary nodules. A computed tomography scan of the head showed a calcified lesion with intra- and extracranial extent. A biopsy of the skull tumor showed an osteoblastic osteosarcoma. Three weeks later, the patient developed two other tumors of the skull, a tumor of the left shoulder and a pelvic pain. Radiographic studies confirmed the presence of further lytic lesions at these sites. The patient was unresponsive to chemotherapy (high dose methotrexate and doxorubicin) and died nine months later. COMMENTS Multifocal osteosarcoma, or osteosarcomatosis, is a highly aggressive form of osteosarcoma. The multiple lesions can all arise synchronously as primary tumors, or appear to be one dominant site with early and rapid appearance of secondary lesions. The incidence is reported to be between 1 and 10% of osteosarcoma. The histology shows an osteosarcoma of osteoblastic type in most cases. CONCLUSION Despite intensive chemotherapy, the prognosis remains poor. The debate remains as to whether or not this clinical presentation represents true multifocality of the disease or a relatively unusual metastatic pattern of osteosarcoma.
Collapse
Affiliation(s)
- S Zafad
- Service d'hématologie et d'oncologie pédiatriques, hôpital 20 Août 1953, Casablanca, Maroc
| | | | | | | | | | | |
Collapse
|
21
|
Pratt CB, Michalkiewicz EN, Rao BN, Lipson M, Cain A, Kaste S. Multifocal osteosarcoma following retinoblastoma. Ophthalmic Genet 1999; 20:23-9. [PMID: 10415462 DOI: 10.1076/opge.20.1.23.2296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Three survivors of retinoblastoma, one with hereditary bilateral and two with nonhereditary (spontaneous) unilateral disease, developed multifocal osteosarcoma. For one patient, unilateral retinoblastoma was followed by primitive neuroepithelioma at age 13 years. Multifocal chondroblastic osteosarcoma represented the patient's third malignant neoplasm. The course of multifocal osteosarcoma in these three patients compares to that of multifocal osteosarcoma which presents de novo in other patients without prior retinoblastoma.
Collapse
Affiliation(s)
- C B Pratt
- St. Jude Children's Research Hospital, Department of Hematology/Oncology, Memphis, TN 38105, USA
| | | | | | | | | | | |
Collapse
|
22
|
Chap LI, Mirra J, Ippolito V, Rentschler R, Rosen P. Miliary osteosarcomatosis with associated hypocalcemia. Am J Clin Oncol 1997; 20:505-8. [PMID: 9345337 DOI: 10.1097/00000421-199710000-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report the case of a patient with a rare miliary variant of osteosarcoma associated with symptomatic hypocalcemia and review the literature regarding the pathogenesis of multifocal osteosarcoma, treatment options, and the associated hypocalcemia.
Collapse
Affiliation(s)
- L I Chap
- Division of Hematology/Oncology, UCLA Medical Center, USA
| | | | | | | | | |
Collapse
|
23
|
Affiliation(s)
- A Taccone
- Department of Radiology, Gaslini Children's Hospital, Genoa, Italy
| | | | | | | | | |
Collapse
|
24
|
Koury ME, Regezi JA, Perrott DH, Kaban LB. "Atypical" fibro-osseous lesions: diagnostic challenges and treatment concepts. Int J Oral Maxillofac Surg 1995; 24:162-9. [PMID: 7608584 DOI: 10.1016/s0901-5027(06)80094-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The term fibro-osseous lesion is a generic designation of a group of jaw disorders (ranging from inflammatory to neoplastic) that microscopically exhibit, a connective-tissue matrix and islands/trabeculae of bone. Although the histologic appearance, and frequently the clinical and radiographic features, may be similar for many of these lesions, they demonstrate a wide range of biologic behavior. Treatment therefore is varied, and there are few well-established guidelines to help the surgeon. Five fibro-osseous lesions with atypical features are presented to demonstrate the diagnostic difficulties associated with these lesions and to show the need for accurate classification in order to help direct treatment and predict outcome. Final diagnoses for "atypical" fibro-osseous lesions included: multiple ossifying fibromas, unclassifiable fibro-osseous lesion, osteosarcoma with concomitant multiple ossifying fibromas, juvenile or psammomatoid ossifying fibroma, and central low-grade osteosarcoma. "Fibro-osseous lesion" should be viewed as a working diagnosis, and a definitive diagnosis should be actively sought; the addition of "atypical" to this designation suggests the likelihood of an aggressive lesion. Treatment of lesions having atypical and nonclassical microscopic features must be based on the biologic behavior of the tumor.
Collapse
Affiliation(s)
- M E Koury
- Department of Oral and Maxillofacial Surgery, University of California San Francisco (UCSF), USA
| | | | | | | |
Collapse
|
25
|
Guest P, Husband J. Case of the month: a lump in the throat. Br J Radiol 1994; 67:1279-80. [PMID: 7874432 DOI: 10.1259/0007-1285-67-804-1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- P Guest
- Department of Radiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | | |
Collapse
|
26
|
Ippolito V, Mirra JM, Fedenko A, Brien EW, Rosen P, Chap L. Case report 827: Miliary osteosarcomatosis. Skeletal Radiol 1994; 23:143-7. [PMID: 8191301 DOI: 10.1007/bf00563212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We presented the case of a 26-year-old woman with a blastic, miliary form of osteosarcomatosis involving the axial skeleton, skull, and long bones to the elbow and knee joint regions who subsequently developed hypocalcemic tetany. Radiologically the lesions mimicked the spread of breast carcinoma, and because of the distribution of the lesions we surmised that the spread was by means of Batson's vertebral plexus of veins. The literature on multiple osteosarcomas was reviewed and an updated clinical subclassification of patients with multiple skeletal osteosarcomas presented.
Collapse
Affiliation(s)
- V Ippolito
- Department of Orthopedic Oncology, Hospital of The Good Samaritan, Los Angeles, California 90017
| | | | | | | | | | | |
Collapse
|
27
|
O'Connell JX, Rosenthal DI, Mankin HJ, Gudger GK, Dickersin GR, Schiller AL, Rosenberg AE. A unique multifocal osteoblastoma-like tumor of the bones of a single lower extremity. Report of a case. J Bone Joint Surg Am 1993; 75:597-602. [PMID: 8478388 DOI: 10.2106/00004623-199304000-00015] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J X O'Connell
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston 02114
| | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Iavarone A, Matthay KK, Steinkirchner TM, Israel MA. Germ-line and somatic p53 gene mutations in multifocal osteogenic sarcoma. Proc Natl Acad Sci U S A 1992; 89:4207-9. [PMID: 1349175 PMCID: PMC525662 DOI: 10.1073/pnas.89.9.4207] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Multifocal osteogenic sarcoma patients without familial histories of increased tumor predisposition were examined for mutations in the highly conserved regions of the p53 gene. p53 point mutations were found in tumor DNA from each of the four patients we examined. A germ-line p53 mutation was detected in one of these patients, and a further rearrangement of the residual wild-type allele was detected in tumor tissue. p53 germ-line mutations can contribute to the enhanced predisposition to tumor development manifest in patients with multifocal osteosarcoma.
Collapse
Affiliation(s)
- A Iavarone
- Department of Neurological Surgery, Preuss Laboratory, University of California, San Francisco 94143
| | | | | | | |
Collapse
|
30
|
Abstract
An eighteen year old female presented with multifocal synchronous osteosarcoma, with multiple skeletal foci of tumour in long bones, pelvis and spine. The radiographically dominant lesion was in the right ilium, and this was considered to be the primary site. There was an extensive osseous pleural plaque and there were also metastases to lungs, peritoneum, abdominal wall, adrenal gland and lymph nodes. A review of the literature reveals that multifocal osteosarcoma is an uncommon condition and is probably due to metastatic disease and not multiple primary lesions. Pleural metastatic disease in osteosarcoma has been seldom reported.
Collapse
Affiliation(s)
- D M Hough
- Department of Radiology, Auckland Hospital, Grafton
| |
Collapse
|
31
|
Benedikt RA, Kransdorf MJ, Jelinek JS, Moser RP. Case report 722. Osteosarcomatosis in a skeletally immature girl. Skeletal Radiol 1992; 21:187-9. [PMID: 1604346 DOI: 10.1007/bf00242134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a case of a clinically and radiographically dominant osteosarcoma of the proximal end of the tibia, in which the second skeletal focus of osteosarcoma was apparent on MRI, after having escaped detection on routine radiographs and scintigraphy. Detection of the second lesion significantly altered the subsequent treatment and prognosis. The improved sensitivity of MRI may increase the accuracy of the diagnosis of osteosarcomatosis. Although further study is needed, MRI study of long bones, especially T1-weighted images in the coronal plane, may be considered as a screening procedure to exclude occult skeletal involvement in patients with osteosarcoma and negative standard metastatic evaluation.
Collapse
Affiliation(s)
- R A Benedikt
- Department of Radiology, Walter Reed Army Medical Center, Washington, DC
| | | | | | | |
Collapse
|
32
|
Firman K, Tamaela LA, Mokoginta S, Kozlowski K. The multiple, sclerotic form of osteogenic sarcoma. AUSTRALASIAN RADIOLOGY 1992; 36:15-6. [PMID: 1632737 DOI: 10.1111/j.1440-1673.1992.tb03064.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- K Firman
- Department of Child Health, Medical School, University of Indonesia, Jakarta
| | | | | | | |
Collapse
|