Parosteal osteosarcoma with myocardial metastasis 13 years after follow-up

Left ventricular metastasis of osteosarcoma: A report of an unusual case

BACKGROUND

Secondary cardiac tumors are far more frequent than primary tumors. Cardiac metastasis of osteosarcoma is extremely rare.

CASE PRESENTATION

We report a 14-year-old child with left femur osteosarcoma that had metastasized to the left ventricle after 30 months of follow-up. The diagnosis was confirmed based on the findings of transthoracic echocardiography and fluorodeoxyglucose positron emission tomography/computed tomography. Surgical removal was indicated in the patient, but his parents refused this decision, and the patient was discharged and admitted to a pediatric oncology center for chemotherapy. The patient died after four courses of chemotherapy.

CONCLUSION

Cardiac metastasis of osteosarcoma is a strong predictor of disease. The demographic differences shown in our case include male sex and a short interval between onset and cardiac involvement.

Parosteal osteosarcoma of the fibula in a middle-aged patient: A case report

RATIONALE

Parosteal osteosarcoma (PO) is relatively rare, accounting for about 1% of primary malignant bone tumors and 4% of all osteosarcomas. Onset is generally at approximately 20 to 40 years of age; the distal posterior surface of femur is the most common site, accounting for more than 60% cases. However, PO in middle-aged or elderly patients is extremely rare and PO occurring in the fibula is even rarer. To our knowledge, this is the first case of PO occurring in the fibula of a middle-aged adult.

PATIENT CONCERNS

We present a case of a 47-year-old female who had a lateral mass on her left knee for 3 months with no obvious cause.

DIAGNOSES

The patient was initially diagnosed with a proximal left fibula tumor via x-ray scan at a local hospital. Subsequently, osteochondroma was highly suspected through computed tomography (CT) and magnetic resonance imaging (MRI) obtained at our hospital. Finally, the postoperative pathological report confirmed PO.

INTERVENTIONS

She underwent a complete resection of the left fibula tumor and received postoperative adjuvant chemotherapy.

OUTCOMES

The patient recovered well and was discharged on the 10th day after admission. Additionally, there was no evidence of recurrence at the 4-year follow-up after surgery.

LESSONS

In middle-aged or elderly patients, early diagnosis of PO in the fibula is difficult and misdiagnosis or missed diagnosis is common. In clinical practice, PO is uncommon in middle-aged or elderly patients, occurs more rarely in the peroneal bone, and should be carefully identified. CT and MRI are essential for diagnosis, with pathological examination being effective for confirmation. Because of the limited reports of PO of the fibula in middle-aged or elderly adults, the present case raises awareness of this rare condition.

Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

BACKGROUND

Although hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. The enhanced resolution of modern CT and MRI scanners may lead to better detection of cardiovascular involvement.

OBJECTIVE

To describe the key imaging findings and clinical behavior of cardiovascular involvement by osteosarcoma.

MATERIALS AND METHODS

We retrospectively reviewed the imaging findings and clinical characteristics of 20 patients with cardiovascular involvement by osteosarcoma identified by two pediatric radiologists from a review of imaging studies at our institution from 2007 to 2013.

RESULTS

At initial diagnosis, the median age of the patients was 15.1 years (range 4.8-24.6 years), and 7 (35%) patients had detectable metastases. Median time to detection of cardiovascular metastases was 1.8 years (range 0-7.3 years). Sixteen patients died of disease; 4 have survived a median of 7.4 years since initial diagnosis. The sites of cardiovascular involvement were the systemic veins draining the primary and metastatic osteosarcoma, pulmonary arteries, pulmonary veins draining the pulmonary metastases, and heart. A dilated and mineralized terminal pulmonary arteriole is an early sign of metastatic osteosarcoma in the lung. Unfamiliarity with the imaging features resulted in under-recognition and misinterpretation of intravascular tumor thrombus as bland thrombus.

CONCLUSION

Knowledge of imaging findings in the era of modern imaging modalities has enhanced our ability to detect cardiovascular involvement and lung metastases early and avoid misinterpreting tumor thrombus in draining systemic veins or pulmonary arteries as bland thrombus.

Local recurrence of a parosteal osteosarcoma 21 years after incomplete resection

Parosteal osteosarcoma (POS) is the most common form of surface osteosarcoma. Its symptoms are insidious and its duration prior to diagnosis is considerably longer than that of other types of osteosarcoma. We report a case of POS with a growing mass but no evidence of metastasis. This tumor, which was diagnosed as calcified hematoma with benign characteristics, was incompletely resected in our hospital 21 years before the diagnosis of recurrence. The patient underwent a wide en bloc resection in our hospital and was free of symptoms, with no signs of tumor recurrence or metastasis during a 53-month follow-up.

Cardiac metastasis of osteosarcoma

Cardiac 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.

Femoral parosteal osteosarcoma 18 years after its discovery: a case report

Osteosarcomas are a heterogeneous group of tumors with diverse anatomical, clinical, and progressional characteristics. Parosteal osteosarcoma, or juxtacortical osteosarcoma, is a rare form of osteosarcoma that develops at the bone surface, but has a better prognosis than other conventional osteosarcomas. We report the observation of a 22-year-old female patient whose initial presentation was an enormous tumefaction of the knee that had been progressing for 10 years. The biopsy concluded in PO of the lower third of the femur. Staging was negative. The tumor had reached an enormous size and required amputation of the left lower extremity. A custom external prosthesis was manufactured to get her back to walking. Eight years after surgery, no local recurrence or metastasis has been detected. Parosteal osteosarcoma is a rare form of osteosarcoma with very slow progression (in spite of the particularly dramatic presentation in our observation), with an excellent prognosis and very rare metastasis.

Late recurrence in primary region of parosteal osteosarcoma: a case report

Recurrence in patients with osteosarcoma after 5 years is a rare condition and has been infrequently reported. Here, the authors present a case of conventional parosteal osteosarcoma that had relapsed 17 years after diagnosis. To their knowledge, this is one of the latest recurrence times in the primary region of osteosarcoma.