Outcome of Radical Surgery for Pulmonary Metastatic Osteosarcoma with Secondary Spontaneous Pneumothorax: Case Series Report

Osteosarcoma Metastasis to the Thorax: A Pictorial Review of Chest Computed Tomography Findings

Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15-20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection and monitoring of these metastases. Lung involvement typically presents as multiple nodules of varying sizes and can include atypical features such as cavitation, cystic lesions, ground-glass halos, intravascular tumor thrombi, and endobronchial disease. Additional Findings: Pleural metastasis often occurs alongside pulmonary disease, and complications like spontaneous pneumothorax may arise. Additional findings may include thoracic lymphadenopathy, cardiac tumor thrombus, and chest wall deposits. Conclusion: Familiarity with these imaging patterns is essential for radiologists to ensure timely diagnosis and effective management. This review highlights the critical role of chest CT in detecting and characterizing osteosarcoma metastasis.

Spontaneous pneumothorax in metastatic osteosarcoma: a case series

Background

Malignancy-associated secondary spontaneous pneumothorax (MSSP) has an incidence of 1% with a risk for recurrence of 9.4% reported in association with sarcomas, histiocytoma, malignant thymoma, and cancers of the breast and thyroid.

Case presentation

We report a series of four patients who presented to us with MSSP associated with pulmonary metastasis of osteosarcoma, all four being young males with metastasis to the lungs. All four patients were non-smokers and had no family history of malignancy. Less than 2% of all spontaneous pneumothoraxes present with bilateral pneumothorax, and our series reports the same in three patients. The occurrence of pneumothorax in two of the patients was in the week following chemotherapy. As there was evidence of pulmonary metastasis in these patients along with the clinical presentation of pneumothorax following chemotherapy, tumor necrosis was considered the likely etiology of spontaneous pneumothorax in these patients. All four patients required intercostal chest drain insertion, and the ICD tubes had to be retained for a prolonged duration due to either persistent air leak or secondary infection. ICD tube insertion further compromised the poor mobility of patients with lower limb lesions due to increased pain and was detrimental to the emotional morale of the patient and caregivers. The 2-year survival in such patients with pneumothorax is less than 10%.

Conclusions

Our series highlights the need for respiratory evaluation and follow-up both clinically and radiologically in cases of osteosarcoma, especially in the immediate post-chemotherapy period.

Surgical Treatment for Pneumothorax and Tumor-bronchial Fistula Secondary to Pulmonary Metastasis of Osteosarcoma in Pediatric and Adolescent Patients

BACKGROUND

Pneumothorax and tumor-bronchial fistula are rare complications of pulmonary metastasis of osteosarcoma.

OBSERVATIONS

We herein report the cases of 3 pediatric and adolescent patients who developed pneumothorax or tumor-bronchial fistula during treatment of pulmonary metastasis of osteosarcoma with chemotherapeutics or antiangiogenic agents. Two patients developed pneumothorax, and the other patient developed tumor-bronchial fistula. All of the patients finally underwent the surgery to treat their complications.

CONCLUSIONS

Although it is not a curative surgery, surgery for pneumothorax and tumor-bronchial fistula is acceptable. The operative procedure should be considered on the basis of the predicted prognosis of the patient.

Simultaneous Bilateral Secondary Pneumothorax Complicating Osteosarcoma: A Case Report

Background:

The incidence of Simultaneous Bilateral Secondary Pneumothorax (SBSP) occurring as a complication of neoplasm is rare, only <1%. The lungs can be the site for spreading metastatic osteosarcoma.

Methods:

We investigated a 16-year-old female who was diagnosed with right distal femur osteosarcoma, pulmonary metastasis, and a rare SBSP complication. Pneumothorax was observed in both sites of pulmonary metastases and bronchopleural fistula by contrasting chest computed tomography.

Results:

This pneumothorax is the second one; the previous one was only on one side, before chemotherapy. 12 months after osteosarcoma was diagnosed and four months after SBSP occurred. The progression of osteosarcoma lesions was the cause of patient’s death. SBSP is the leading cause of severe complications in osteosarcoma.

Conclusion:

The clinician must perform diagnostic strategies for early detection of osteosarcoma and its proper management, which can reduce a patient’s suffering and impairment of the patient’s quality of life, thus decreasing morbidity and risk of mortality.

A case of secondary pneumothorax due to multiple pulmonary metastases of granulosa cell tumor

Introduction

Ovarian granulosa cell tumor is a relatively rare tumor that accounts for 2-5% of malignant ovarian tumors. This tumor progresses slowly and may recur late in life.

Case presentation

A 70-year-old woman was admitted to our hospital with a left secondary pneumothorax due to metastatic lung tumors of granulosa cell tumor. Reports of secondary pneumothorax due to granulosa cell tumor are rare. Thoracoscopic suturing and pleurodesis using talc were effective in the treatment of this pneumothorax.

Conclusions

We experienced a rare case of secondary pneumothorax due to multiple pulmonary metastases of granulosa cell tumor. It should be noted that pulmonary metastasis of granulosa cell tumor can lead to secondary pneumothorax.

Pathogenesis of Secondary Spontaneous Pneumothorax Complicating Osteosarcoma

This report describes a rare case of osteosarcoma of the right distal femur and secondary spontaneous pneumothorax in a 13-year-old girl. Secondary spontaneous pneumothorax complicating metastatic osteosarcoma is a rare but well-known phenomenon, with several suggested hypotheses for its pathogenesis. However, these hypotheses have not been confirmed. In the present case, the pathogenesis of secondary spontaneous pneumothorax complicating metastatic osteosarcoma was determined grossly, radiologically, and histopathologically. These findings may help to clarify further the pathogenesis of secondary spontaneous pneumothorax complicating metastatic osteosarcoma.

Pulmonary Relapse of Osteosarcoma Following Presentation With a Pneumomediastinum and Localized Disease at Diagnosis

Pneumothorax is a well-described complication of osteosarcoma. Conversely, the presence of a pneumomediastinum to our knowledge has been reported just once in a patient with osteosarcoma, and never without detectable lung metastasis. We report the case of an 18-year-old male with a localized, distal femur osteosarcoma who was found to have an asymptomatic pneumomediastinum and pneumatocele at diagnosis, and then 16 months later experienced a pulmonary relapse. Our case suggests that these findings may represent the presence of occult metastatic disease and cautions providers to treat appropriately and provide surveillance with a high index of suspicion for pulmonary recurrence.

Bilateral spontaneous pneumothorax in an osteosarcoma patient with pulmonary metastases: A case report

Spontaneous pneumothorax is a rare complication of chemotherapy in the treatment of lung neoplasms. It is relatively common in osteosarcoma lung metastases patients following chemotherapy, but the cause is still unknown. Here, we report a case of bilateral spontaneous pneumothorax occurring in a 40-year-old female in whom lung metastases from osteosarcoma were treated with combination chemotherapy. The patient had osteosarcoma on the right side of the mandible, and developed bilateral spontaneous pneumothorax. Through contrasting chest computed tomography, pneumothorax was identified at the site of the pulmonary metastases and occurred following the formation of bullae. The pneumothorax and bullae were produced after the patient received chemotherapy. In October 2014, the patient succumbed to the disease due to hemorrhage of the primary osteosarcoma lesions.