Abstract
BackgroundVenous tumor thrombus (VTT) in pelvic osteosarcoma has been regarded as a rare oncological condition and few literatures investigated this issue.MethodsWe retrospectively reviewed 115 cases of pelvic osteosarcoma treated in our center from 2006 to 2016. Diagnosis of VTTs was made based on histo‐pathological findings. We summarized the radiological manifestations of VTTs on CT, MRI, and PET/CT. We also compared the demographical, oncological, and radiological data between cases with or without VTTs to identify its predisposing factors.ResultsSeventeen cases (14.8%) were diagnosed with VTT. Manifestations of VTTs on CT included increased caliber (64.7%), calcification (47.1%), low density on plain scan (100%), filling defect (100%), and streak‐like enhancement (35.7%) on contrast enhancement. On MRI, the VTTs could be hypo‐ or iso‐intense on T1WI (100%), hyperintense on T2WI (100%), and filling defect on contrast enhancement (100%). PET/CT showed high metabolic activity of the VTTs. The ranges of the VTTs included unilateral external iliac vein (EIV) (two cases), unilateral internal iliac vein (IIV) (one case), unilateral common iliac vein (CIV) and IIV (five cases), unilateral CIV + EIV (two cases), inferior vena cava (IVC) and unilateral CIV + EIV (one case), IVC and unilateral CIV + IIV (four cases), IVC and bilateral CIVs + IIVs (two cases). Multivariate analysis indicated that chondroblastic subtype and involvement of L5/S1 intervertebral foramen might predispose to VTTs.ConclusionThe incidence of VTTs in pelvic osteosarcoma was 14.8%. Comprehensive radiological studies help preoperative diagnosis of VTTs. Predisposing factors included chondroblasic subtype and involvement of L5/S1 intervertebral foramen.
Highlights
It is necessary to investigate on Venous tumor thrombus (VTT) in pelvic osteosarcomas and figure out its incidence, radiological manifestations, and predisposing factors in order to help practitioners to identify and manage this oncological condition
We retrospectively reviewed the charts of patients with pelvic osteosarcomas treated in our center from January 2006 to December 2016
In this retrospective study based on 115 cases of pelvic osteosarcoma, we found that the incidence of VTTs in pelvic osteosarcoma was 14.8%, and that radiological examinations such as computed tomography (CT), Magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) could help identify the VTTs preoperatively, and that chondroblastic subtype and invasion of L5/ S1 intervertebral foramen were correlated with the occurrence of VTTs
Summary
Venous tumor thrombus (VTT) is not uncommonly seen in some retroperitoneal malignancies such as renal cell carcinoma[1] and is occasionally noted as a rare condition in patients with osteosarcoma according to the previous literature.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17] Almost all of the literal records about VTT in osteosarcoma were case reports with extremely poor outcomes and the pelvic ring was the most common location of those cases.[1,4,6,7,8,9,11,13]. Pelvic osteosarcomas accounted for only
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