FROM BONE TO BRONCHUS: HIP OSTEOSARCOMA WITH LUNG METASTASIS

Abstract

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: A 44-year-old male with past medical history of left hip osteosarcoma status post resection in 2017 presented with cough and shortness of breath. CASE PRESENTATION: Chest x-ray revealed extensive cannonball type appearing bilateral lung involvement which was confirmed by CT angiography as being concerning for metastasis. This was confirmed by lung biopsy as pulmonary metastasis of his hip osteosarcoma. DISCUSSION: Osteosarcoma is a relatively uncommon tumor in adults with an incidence of roughly 500 new cases per year in the US. 10 to 20 percent present with a metastatic process with the lung being the most common site. Several risk factors have been identified including prior radiation or chemotherapy in childhood, Paget’s, fibrous dysplasia, chronic osteomyelitis as well as inherited conditions such as retinoblastoma, Li-Fraumeni and Rothmund-Thomson syndrome. Noteworthy of osteosarcoma is the lack of characteristic translocations or identifiable genetic abnormalities, unlike other types of sarcomas. CONCLUSIONS: Extensive staging workup is crucial for these patients as those with metastatic disease have a significantly worse outcome but half of cases with limited pulmonary involvement are amenable to cure. CT is the current gold standard for evaluation of metastatic disease in the thorax although a recent study demonstrated that more than one third of pulmonary mets would be missed unless an open thoracotomy was done with manual palpation of the lung. This further necessitates the importance of close monitoring as well as a multi-faceted approach with chemo and metastectomy which could significantly extend survival times. Reference #1: “The metastatic patterns of osteosarcoma”. Jeffree GM, Price CH, Sissons HA. Br J Cancer. 1975;32(1):87. Reference #2: “Current treatment of osteosarcoma”. Ferguson WS, Goorin AM. Cancer Invest. 2001;19(3):292. Reference #3: “Osteosarcoma over the age of forty”. Grimer RJ, Cannon SR, Taminiau AM, Bielack S, Kempf-Bielack B, Windhager R, Dominkus M, Saeter G, Bauer H, Meller I, Szendroi M, Folleras G, San-Julian M, van der Eijken J. Eur J Cancer. 2003;39(2):157. DISCLOSURES: no disclosure on file for Mohammad Al-Ameri; No relevant relationships by Raashi Chawla, source=Web Response No relevant relationships by Daymon Peterson, source=Web Response No relevant relationships by Tanaz Salimnia, source=Web Response