Periosteal osteosarcoma in the hand of a pediatric patient: a case report

We report a case of periosteal osteosarcoma, an uncommon juxtacortical osteosarcoma variant, in the metacarpal of a 5-year-old girl treated with wide excision and chemotherapy with no recurrence at 25 months.     

Periosteal chondroma of the cuboid with secondary aneurysmal bone cyst in a setting of secondary hyperparathyroidism

We report the case of a 35-year-old woman with painful, nontender mass at the right lateral hindfoot. Computed tomography (CT) and magnetic resonance imaging (MRI) indicated the suspect of a chondroid tumour in the cuboid. The tumour was resected en bloc and histology revealed the presence of a periosteal (juxtacortical) chondroma with secondary aneurysmal bone cyst. Secondary hyperparathyroidism was detected in laboratory tests and put into context with the histopathologic findings. In conclusion, a rare case of periosteal chondroma of the cuboid with secondary aneurysmal bone cyst in a setting of secondary hyperparathyroidism due to vitamin D deficiency is presented.Level of clinical evidence: 4.     

Periosteal chondroma of the rib possibly associated with hemothorax: a case report

We report on a case of spontaneous hemothorax occurring in a 13-year-old boy with periosteal chondroma of the rib. Periosteal chondromas are rare, particularly in the ribs. To the best of our knowledge, this is the first report of periosteal chondroma of the rib associated with hemothorax.     

Multicentric synchronous osteosarcoma: a case report with autopsy findings

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. Received for publication on May 18, 1999; accepted on Sept. 27, 1999     

Primary osteosarcoma of the breast: a case report

We report a rare case of primary osteosarcoma of the breast in a postmenopausal patient without any association to either trauma or an underlying tumor. Clinical, radiographic, and histologic illustrations as well as a review of the literature are presented.     

Parosteal osteosarcoma: case report and review of the literature

BACKGROUND: The majority of osteosarcoma cases of the head and neck are high-grade lesions. We present a case and discuss the diagnostic and therapeutic implications of a rare low-grade parosteal osteosarcoma of the maxilla. METHODS: A 32-year-old man presenting to the Head and Neck Surgical Oncology clinic with a 1-year history of a firm palatal mass. Evaluation clinically and radiographically raised the suspicion of an osteosarcoma. RESULTS: A partial maxillectomy revealed a parosteal osteosarcoma with negative margins. No adjuvant therapy was recommended, and the patient remains without evidence of local recurrence after 3 years. CONCLUSIONS: Parosteal osteosarcomas of the head and neck region are rare, low-grade variants of osteosarcoma, but have the potential to recur with simple local excision. Clinical and radiographic features are diagnostically helpful. Definitive diagnosis comes from histopathology, and wide local resection should be employed as the optimal treatment.     

A primary extraskeletal osteosarcoma of the mesentery: a case report

Extraskeletal osteosarcoma is a rare and invasive malignancy, typically located in the soft tissue without attachment to the skeleton. The present study reports a case of a primary mesenteric extraskeletal osteosarcoma of a 71-year-old woman. The patient complained of an incomplete defecation. Colonoscopy showed an ulcer with impression of external compression of the sigmoid. An additional abdominal computed tomography (CT) scan revealed a large, almost completely calcified, mass in the left lower abdomen causing hydronephrosis of the left kidney. The patient underwent surgery and the mass was resected completely. The histopathological diagnosis was a primary abdominal extraskeletal osteosarcoma arising from the mesocolon with local invasion of the sigmoid. She was in follow-up without adjuvant chemo- or radiotherapy. Five months after initial surgery the tumor recurred with widespread peritoneal metastasis.     

Extraskeletal osteosarcoma of the pleura: a case report

We herein present an exceedingly rare case of pleural osteosarcoma that was surgically resected in an elderly patient. A 74-year-old man, complaining of a dry cough and breathlessness on effort, was found to have massive pleural effusion on a chest X-ray. The chest CT and MRI scans indicated a massive effusion and a pleural tumor encasing the left lower lung. The resected tumor was histologically an osteosarcoma, measuring 11.3 × 9.0 × 6.0 cm. Because there was no evidence of any other primary tumor, the diagnosis of extraskeletal osteosarcoma was appropriate.     

Primary renal osteosarcoma: A case report

Primitive renal osteosarcoma is a rare sarcoma of the kidney with only 27 cases reported in the literature. Its histogenesis is poorly understood. It occurs at an older age between the fifth and seventh decade of life with a male predominance. The clinical features are similar to other renal diseases. Imaging shows calcifications within a lumbar or flank mass. Histology describes a sarcomatous proliferation producing osteoid, most often at an advanced stage (pT4), which implies a poor prognosis. We report on the clinical and pathologic features of a case of primary renal osteosarcoma in a 56-year-old man with stage IV disease. This is the 28th case of primitive renal osteosarcoma reported in the literature, confirming the highly malignant nature of this tumor and the need for early diagnosis.     

Diagnostic evaluation and treatment of primary breast osteosarcoma: A case report

Primary breast osteosarcoma (PBO) is a rare tumor of the breast, with only case reports and small case series published in the literature. Classic imaging findings of sunburst calcifications, a rim of intermediate density, and intense uptake on bone scintigraphy can help make the correct diagnosis preoperatively, allowing for appropriate surgical and chemotherapeutic management. We present the imaging evaluation, treatment course, and follow‐up of a case of PBO diagnosed in a 67‐year‐old patient.     

Low-grade central osteosarcoma mimicking fibrous dysplasia: a report of two cases

Low-grade central osteosarcoma is an unusual variant of conventional osteosarcoma. We present here two rare cases of low-grade central osteosarcoma resembling fibrous dysplasia. A 24-year-old woman diagnosed as fibrous dysplasia was treated with intra-lesional excision and curettage of the tumor but tumor recurred at 4 months after surgery. Distal femoral en-bloc resection was performed followed by arthroplasty with mega-prosthesis of the knee. A 57-year-old man diagnosed as central osteosarcoma was treated with wide excision of the tumor, followed by reconstruction with the vascularized fibula graft combined with an autogenous irradiated bone graft. Because of the difficulty in distinguishing low-grade central osteosarcoma from a benign lesion, open biopsy is needed to obtain a large tumor sample. Careful clinical and pathological evaluation is required to obtain a definite diagnosis. The treatment of low-grade central osteosarcoma is en-block resection with wide surgical margins.     

右肱骨富于巨细胞性骨肉瘤1例

富于巨细胞性骨肉瘤是骨肉瘤的一种罕见类型,病理学上易误诊为巨细胞瘤.由于两者的治疗方法有差异,所以误诊往往影响术者选择正确的手术方法.本文治疗1例富于巨细胞性骨肉瘤的患者(女,16岁),术中行右肱骨近端肿瘤切除同时取不带血管的自体腓骨移植重建肱骨头及肱骨干,术后肩关节保留部分功能.     

保留骨骺灭活再植术治疗儿童股骨远端骨肉瘤

[目的]探讨保留骨骺灭活再植术的临床应用注意事项及并发症的防治。[方法]回顾6年间所治疗的11例患者,男5例,女6例。平均年龄7.6岁。均位于股骨下端。MRI分型:Ⅰ型7例,Ⅱ型4例。1例合并病理骨折。治疗方法均采用术前化疗2疗程 保留骨骺灭活再植手术 术后化疗。[结果]手术时间为3~4 h。术中出血量为300~500 ml。无血管、神经损伤。术后切口一期愈合,无切口感染及切口延迟愈合。11例获得随访10~72个月,患膝屈曲>110°3例,90°~110°3例,60°~89°4例,<60°1例。下肢等长4例,患肢较健侧短<2 cm 5例,2~3cm 2例。复发1例,转移2例,死亡3例,螺钉松动1例,灭活骨骨折1例。[结论]保留骨骺灭活再植术有利于术后功能恢复和肢体长度的保持;严格无瘤及无菌操作、彻底引流、适当延长外固定的时间、功能锻炼时注意保护肢体等是预防并发症发生的主要措施。     

Chondroblastoma with secondary aneurysmal bone cyst of the hamate: case report

Chondroblastoma of the carpals is rare, can mimic other benign bone tumors, and presents a diagnostic challenge. There have been few cases of benign tumors involving the hamate, with only one reported case of chondroblastoma, which was treated with complete hamate excision. We present a case of chondroblastoma with secondary aneurysmal bone cyst of the hamate treated with curettage, high-speed burring, phenol, and autogenous iliac crest bone grafting. At the time of the most recent radiographic follow-up, there was full graft incorporation, preserved hamate morphology, and no evidence of recurrence.     

Periosteal osteosarcoma of the femur treated with modified capanna procedure: A case report

IntroductionPeriosteal osteosarcoma is a rare type of primary bone tumor. A vascularized fibula graft incorporates this revolutionary approach with a traditional massive allograft to reconstruct large femur and tibia defects during oncological resection. A structurally competent reconstruction with improved vascular and osteogenic capacities with the ability to achieve lower rates of fracture, infection, and non-union is obtained by integrating the benefits of this separate components.MethodA 16-year-old female diagnosed with periosteal osteosarcoma of the left shaft femur. We performed neoadjuvant chemotherapy, limb salvage surgery consists of surgical resection and reconstruction, followed by adjuvant chemotherapy post operatively. We used the modified Capanna procedure to salvage the femur.ResultPost-operative evaluation showed stable fixation clinically and radiologically. There were no complications observed during recovery, as both distal motor and sensory are normal eventhough the patient were still limited in the motion of the hip and knee at the time due to post-operative pain.DiscussionCappana procedure has been known as a novel surgical method that could decrease the risk of complications results from classic reconstruction method, such as fracture, non-union, and infection.ConclusionModified Cappana procedure which introduce the use liquid nitorgen-recycled autograft from the resected affected bone as a peripheral shell supporting a centrally placed vascularized fibular graft to fill the massive bone defect left by surgical resection, had successfully performed in our patient whom previously diagnosed with periosteal osteosarcoma of femoral shaft.     

Bone deposition,bone resorption,and osteosarcoma

Bone deposition and bone resorption are ongoing dynamic processes, constituting bone remodeling. Some bone tumors, such as osteosarcoma (OS), stimulate focal bone deposition. OS is the most common primary bone tumor in children and young adults. A complex network of genes regulates bone remodeling and alterations in its expression levels can influence the genesis and progression of bone diseases, including OS. We hypothesized that the expression profiles of bone remodeling regulator genes would be correlated with OS biology and clinical features. We used real‐time PCR to evaluate the mRNA levels of the tartrate‐resistant acid phosphatase (ACP5), colony stimulating factor‐1 (CSF1R), bone morphogenetic protein 7 (BMP7), collagen, type XI, alpha 2 (COL11A2), and protein tyrosine phosphatases zeta 1 (PTPRZ1) genes, in 30 OS tumor samples and correlated with clinical and histological data. All genes analyzed, except CSF1R, were differentially expressed when compared with normal bone expression profiles. In our results, OS patients with high levels of COL11A2 mRNA showed worse overall (p = 0.041) and event free survival (p = 0.037). Also, a trend for better overall survival was observed in patients with samples showing higher expression of BMP7 (p = 0.067). COL11A2 overexpression and BMP7 underexpression could collaborate to OS tumor growth, through its central role in bone remodeling process. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1142–1148, 2010     

Secondary osteosarcoma arising in fibrous dysplasia,case report

Malignant transformation of fibrous dysplasia is very rare. The frequency is increased in polyostotic forms, in McCune–Albright and Mazabraud’s syndromes and previously irradiated cases. Pain, which is rapidly becoming worse over a short period unrelated to trauma is the most alarming symptom. Early radiological features of sarcomatous transformation are moth-eaten or cystic areas of osteolysis, cortical destruction and gradual formation of a soft tissue mass. The prognosis is unfavorable as most of the cases are in an advanced stage in the time of diagnosis. We present an unusual case of unsuspected secondary osteosarcoma arising in a previously unirradiated, monostotic fibrous dysplasia. A 46-year-old woman was admitted with hip pain, which worsened after a minor trauma occurred 1 year ago. Plain graphies of left femur showed a well-delineated lesion with endosteal scalloping and areas having a ground-glass appearance. The MRI revealed minimal contrast enhancement but no heterogenous signal intensity, cortical destruction, periost reaction or accompanying soft tissue component was noted. The lesion was initially curetted. But being diagnosed as osteosarcoma histologically, classical osteosarcoma protocol pre and postoperative chemotherapy was applied. Resected femur showed areas of fibrous dysplasia admixed with osteosarcoma having fibroblastic, chondroblastic and osteoblastic areas that were focally invading the soft tissue. Tumor viability was estimated as 95%. The clinical course worsened rapidly after the operation. She did not respond to postoperative chemotherapy and lost with pulmonary metastases less than a years’ time after the operation. The case is presented to increase awareness on the possibility of malignant transformation in an otherwise unsuspected fibrous dysplasia.