An unusual case of primary osteosarcoma of the rib in an adult

Rosette-forming epithelioid osteosarcoma in the rib: a rare case of location and morphology

The rib is an unusual location for osteosarcoma and is reported in only 2% of all cases. The major histological variants of osteosarcoma are osteoblastic, chondroblastic, and fibroblastic, with a few rare variants including one epithelioid type. This report describes a 44-year-old male with an osteolytic mass in the right seventh rib. Histological examination revealed osteosarcoma with unique features of epithelioid appearance and rosette structures. To the best of our knowledge, this is the first reported case of a rosette-forming osteosarcoma of the rib that showed epithelioid morphology. Despite successful surgery, the patient’s prognosis was poor because this malignancy had an unusual location within the axial skeleton and was a rare histological variant.

The Spectrum of Rib Neoplasms in Adults: A Practical Approach and Multimodal Imaging Review

OBJECTIVE. Adult neoplasms of the ribs are a heterogeneous group consisting of both benign and aggressive entities. Rib neoplasms have a variety of overlapping imaging features, with much of the imaging data disjointed across the musculoskeletal, thoracic, and oncologic imaging literature. Arrival at accurate diagnosis can therefore be quite challenging. This article consolidates this information and introduces the reader to an algorithmic approach to rib lesion evaluation based on imaging. CONCLUSION. Rib neoplasms are a diverse group of benign and malignant entities, which often makes determining an accurate diagnosis challenging. Evaluation requires a multipronged approach that incorporates radiographic imaging features, nonradiographic imaging findings, lesion location, and clinical data.

Radical resection of a giant rib osteosarcoma with complex chest wall reconstruction

•

A 61-year-old male with a 20 cm primary osteosarcoma of the rib underwent a radical en bloc chest wall resection.

•

Chest wall reconstruction was performed using a poly methyl methacrylate (“bone cement”) and polypropylene mesh “sandwich”.

•

Functional, cosmetic, and oncologic outcomes at 6 months are excellent.

•

Polypropylene mesh and “bone cement” represent a safe, easy, and affordable approach to reconstructing the rib cage even in cases of large defects.

Introduction

Primary rib osteosarcoma is a rare chest wall tumor with variable presentation. Large tumors greater than 10 cm are even rarer and present a challenge for surgical management.

Presentation of case

A 61-year-old male with a giant osteosarcoma of the left 2^nd rib underwent multidisciplinary management including induction therapy with doxorubicin and cisplatin, followed by en bloc resection with left ribs 1–5, spinous processes of ribs 2–5, small volume lung resection, and chest wall reconstruction with polypropylene mesh and poly methyl methacrylate (PMMA or bone cement). There were no perioperative complications. At 6 months follow-up, the patient remains disease-free. Functional and cosmetic outcome are excellent.

Discussion

This 20 cm mass and resection of ribs 1–5 with resulting 25 cm chest wall defect is the largest primary rib osteosarcoma reported in literature. An R0 resection and chest wall reconstruction using polypropylene mesh and bone cement was feasible and safe.

Conclusion

Giant chest wall defects involving multi-rib resection can be effectively reconstructed with commonly available and inexpensive polypropylene mesh and PMMA to achieve good cosmetic and functional outcomes.

A rare rib lesion due to parosteal osteosarcoma: a case report

Introduction

Masses which develop on the surface of the rib bones are rare. The differential diagnosis includes benign and malignant lesions.

Case presentation

A 23-year-old European woman presented at an out-patient clinic with a 9-month history of a painless swelling on the right posterolateral side of her chest wall. The case reported here is of a very rarely seen parosteal osteosarcoma of the rib that was treated with wide resection and chest wall reconstruction. There was no evidence of local recurrence or distal metastasis after a 1-year follow-up.

Conclusion

Parosteal osteosarcoma is a locally aggressive malignant tumor, and resection with a wide margin is the most appropriate treatment. Correct diagnosis of parosteal osteosarcoma is challenging for an orthopedic surgeon. Although rare, in the differential diagnosis of lesions located on the ribs, parosteal osteosarcoma should be considered and a systematic diagnostic approach should be taken.

The Management Challenges in an Unusual Case of Primary Osteosarcoma of the Rib in an Adult Patient

Primary osteosarcomas are derived from primitive bone-forming mesenchymal stem cells and most often originate in the metaphysis of the long bones of children and adolescents, but it occurs very rare in adults. Approximately 10% of osteosarcomas are located in the flat bones, pelvis being the main site. Involvement of flat bones like rib may be seen as a metastatic process or secondary to chemotherapy, but a primary osteosarcoma rib is extremely rare. Osteosarcoma originating from such rare sites poses numerous diagnostic and therapeutic challenges, and we report one such case in a 24-year-old male patient. Our case highlights the fact that osteosarcoma of the rib, although rare, should be considered in the differential diagnosis of primary malignant neoplasms of the rib even in the adult population. Further, early prompt diagnosis and aggressive multimodality management are cornerstones of management and will help improve the survival outcomes.

Primary Osteosarcoma of the Rib Identified on Bone Scintigraphy

Osteosarcomas generally arise in appendicular skeletons, but rarely in the ribs. We described Tc-MDP bone scan findings from a 23-year-old man with right back pain. The images demonstrated elevated activity in the region overlapping the posterior 8th to 10th ribs and in the L9-10 vertebral bodies. CT showed an 8.8 × 8.3 cm mildly peripherally calcified mass arising from the right 10th rib involving the 9th and 10th thoracic vertebrae. Pathological examination confirmed primary osteosarcoma of the rib.

MiR-223/Ect2/p21 signaling regulates osteosarcoma cell cycle progression and proliferation

Osteosarcoma is one of the most common tumors. The mechanisms of formation and development of osteosarcoma have been studied for a long time. Recently, more and more evidence showed that miRNAs play important roles in regulating tumor growth. In this study we found that miRNA-223 was downregulated in both osteosarcoma patients' tumor tissues and osteosarcoma cell lines. Overexpression of miRNA-233 greatly inhibited the proliferation of Saos-2 cells. Cell cycle analysis by flow cytometry showed the arrest of cell cycle progression at the G1 phase. Further mechanistic study indicated that Ect2 was directly targeted by miR-223. Downregulation of Ect2 by miR-223 induces the expression of p21, p27 and the phospharylation of retinoblastoma, which are involved in the G1 block. We concluded that miR-223 functions as a tumor suppresser in osteosarcoma and miR-223/Ect2/p21 signaling is an important pathway that regulates the osteosarcoma cell cycle progression and proliferaion.

Primary parosteal osteosarcoma of the rib

Osteosarcoma is a common primary malignant tumour of bones that produces an osteoid matrix. Parosteal osteosarcoma is an uncommon neoplasm and principally affects the long bones, especially in the distal femur, proximal tibia and proximal humerus. Rarely, the tumour may arise in a flat bone, and rib involvement is very infrequent. An unusual case of primary parosteal osteosarcoma of the rib in an asymptomatic 28-year old female is presented here. A chest X-ray film suggested an intrapulmonary homogeneous mass, while a computed tomography scan revealed a broad-based calcified mass attached to the inner cortex of the right fourth anterior rib. The patient underwent a wide excision of the tumour together with adjacent intercostal muscles and chest wall reconstruction. Postoperative histopathological outcome was consistent with primary parosteal osteosarcoma.