OSTEOSARCOMA

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OSTEOSARCOMA
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OSTEOSARCOMA

• General Considerations
• 2nd m/c primary malignancy
• Neoplastic osteoid and bone matrix formed by
  malignant cells of connective tissue
• Vast majority are primary osteosarcoma
• Secondary osteosarcoma
• Pagets disease, fibrous dysplasia
• Central (m/c), juxtacortical

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OSTEOSARCOMA

• Clinical
• Males 21, 10-25 yoa
• Bone pain, swelling, occasional soft tissue mass,
  warmth and pyrexia
• Pain may be insidious, transitory at first
  prolonging diagnosis
• 1st symptom may be related to path fx

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OSTEOSARCOMA

• Pathology and Laboratory
• Pathology
• Mixed and sclerotic presentations m/c
• Lytic lesions
• Laboratory
• Alkaline phosphatase may be elevated

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OSTEOSARCOMA

• Skeletal Location
• M/C location ? distal femur
• 50-75 involve the knee
• Proximal humerus, calvarium, sacrum and pelvis
• Older patients ?flat bones involved most often

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OSTEOSARCOMA

• Radiographic
• Typically originate in metaphysis
• May extend to epiphysis after closure
• Medullary and cortical destruction
• Aggressive periosteal responses
• Sunburst is classic
• Hair-on-end, Codmans triangle
• Occasionally laminated response

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OSTEOSARCOMA

• Radiographic
• Soft tissue mass is common
• Tumor new bone within the destructive lesion or
  at its periphery
• Cumulus cloud appearance
• MRI good for evaluating the intraosseous tumor
  extension and soft tissue involvement
• Positive bone scintigraphy

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OSTEOSARCOMA

• Complications
• Metastasis Pulmonary and osseous
• Hematogenous to lungs m/c
• Cannon-ball metastasis
• Can lead to pneumothorax
• Pathologic fracture

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OSTEOSARCOMA

• Prognosis and Treatment
• 5 year survival now exceeds 50
• Limb salvage techniques
• Multi-drug chemotherapy
• May require amputation

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PAROSTEAL OSTEOSARCOMA

• General Considerations
• Type of surface osteosarcoma
• Most are considered low-grade tumors
• M/C in patients between 25-40
• Dull aching pain, swelling or soft tissue mass

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PAROSTEAL OSTEOSARCOMA

• Radiographic
• Dense oval or spherical shaped mass
• Attached to the cortical surface
• May see a radiolucent cleft separating a portion
  of the mass from the bone