A case of parosteal osteosarcoma with a rare complication of myositis ossificans

Maria Silvia Spinelli,Carlo Della Rocca,Jendrick Hardes,Carlo Barone,Carlo Perisano,Giulio Maccauro,Carlo Fabbriciani

doi:10.1186/1477-7819-10-260

Abstract

We report the case of a parosteal osteosarcoma of the distal ulna, treated with wide resection without reconstruction. The patient developed lung metastasis and a mass in the interosseus membrane of the forearm proximally to the osteotomy. The lung mass was found to be a metastasis from parosteal osteosarcoma and the biopsy of the forearm mass revealed a myositis ossificans. The suspicion of a recurrence of parosteal osteosarcoma, already metastatic, led to a second wide resection with no reconstruction. A slice of the radial cortex was taken during this second procedure. From a histological point of view, good margins were achieved and diagnosis of myositis ossificans was confirmed. Two months later, a radius fracture occurred and a synthesis, with plate and screws, as added with poly(methyl methacrylate) (PMMA) to reconstruct the bone loss, was performed. Indication of the reconstructive technique and the complication after distal ulna resection in oncologic surgery are discussed in this paper.

Highlights

Parosteal osteosarcoma is the most common type of osteosarcoma originating from the cortex, accounting for 5% of all osteosarcomas [1]
Given the lack of consensus in the literature on this rare condition, we present our clinical case in which parosteal osteosarcoma was treated without reconstruction, along with complications occurring after our surgical procedure
While resection of the ulna is often relatively easy to perform, problems arise in the reconstruction of the defect

Summary

Introduction

Parosteal osteosarcoma is the most common type of osteosarcoma originating from the cortex, accounting for 5% of all osteosarcomas [1]. Due to the rarity of the localization, distal ulna resection and reconstructive options after oncologic surgery are still debated. The patient underwent an en-bloc resection of the distal ulna (15 cm from the ulno-carpal joint) with disarticulation of the ulno-carpal joint, performed by the orthopedic oncologic senior surgeon (Figure 3).

Results

Conclusion