Case Of Extraskeletal Osteosarcoma Research Articles

Extraskeletal Osteosarcoma in the Thigh Recognized Following Acute Traumatic Injury: A Case Report and Review of the Literature

Extraskeletal osteosarcoma is a rare mesenchymal malignancy arising in soft tissue that produces osteoid, neoplastic bone, or chondroid material without demonstrable attachments to bone or periosteum. We report an instructive case of extraskeletal osteosarcoma in a 42-year-old woman recognized following acute traumatic injury of her left thigh.

Anal extraskeletal osteosarcoma in a man: a case report and review of the literature

BackgroundOsteosarcoma is a common malignancy of bone that usually occurs in individuals in the age range of 0–24 years. Extraskeletal osteosarcoma is a rare tumor presentation which originates in non-bony tissues. Extraskeletal osteosarcoma comprises 2–5% of all osteosarcomas and less than 1% of all soft tissue sarcomas. As compared to bone-derived osteosarcoma, extraskeletal osteosarcoma occurs in older age groups. Extraskeletal osteosarcoma has a poorer prognosis than bone osteosarcoma. To the best of our knowledge, this is the first case of extraskeletal osteosarcoma in the anal region.Case presentationA 70-year-old Hazara man presented to a private hospital with the chief complaints of constipation, bloody defecation, and pain during defecation of 1.5 months’ duration. His past history was unremarkable. A digital rectal examination showed a solid growth in the middle part of his anus. A colonoscopic examination was done and showed a solid mass in his anal region. A computed tomography scan revealed an irregular mural thickening in the anal canal with heterogeneous enhancement. The maximum length of the involved segment was measured to be 4.5 cm. No suspicious lesions were noted in other organs. An abdominoperineal resection was performed on our patient. A 22 cm in length resected segment of his colon, consisting of the lower sigmoid, rectum, and anus was sent to us for histopathological examination. Gross examination revealed a polypoid dark-gray tumor measuring 5 × 3 × 2 cm. The cut section revealed gray and white appearance with firm-to-hard consistency and foci of ossification. Microscopic examination revealed normal anorectal mucosa and a spindle cell malignant neoplasm with osteoid formations. No evidence of epithelial carcinoma was noted. Immunohistochemical stains were positive for stabilin-2 and negative for cytokeratin, which confirmed the diagnosis of osteosarcoma.ConclusionExtraskeletal osteosarcoma of the colon is rare and presence of the tumor in the rectum and anal region is extremely rare. Radiology, colonoscopy, and histopathology with immunostaining are required for the diagnosis. The accurate diagnosis of extraskeletal osteosarcoma is important as it has a different regimen of treatment with poorer prognosis compared to primary osteosarcoma of the bone.

Cystic extraskeletal osteosarcoma: Three case reports and review of the literature.

Extraskeletal osteosarcoma is a rare soft tissue sarcoma and typically appears as a solid mass with variable mineralization. A few cases of extraskeletal osteosarcoma have shown extensive hemorrhagic changes or bleeding due to its high-grade malignancy; however, to the best of our knowledge, no previous reports have described the pathological characteristics of tumors with non-hemorrhagic cystic change. The present report discusses three cases involving cystic lesions with a solid area at the periphery that arose in soft tissues. The large cystic spaces contained only yellowish-brown fluid and little or no blood, with no clear pathological necrotic tissue. The solid component comprised a focal area of osteoid production by highly anaplastic sarcomatous cells. All of the cases showed high-grade malignancy histologically, and the average maximum diameter was approximately 175 mm. The tumors were located at the adductor muscles in two cases and at the intermuscular region of the hamstring muscles in one case. All of the patients consulted a doctor after more than half a year had passed since the recognition of swelling or a mass on their affected extremities. Surgical treatment was performed for all patients. One patient had lymph node metastasis, and another had lymphoedema after surgery, but no histological invasion to the lymphatic ducts was observed in the excised specimen. Degenerative changes in the fluid content over a long time-course as a result of tumor bleeding or necrosis, rather than lymphorrhea by lymphatic channel invasion of the tumor, might have contributed to the formation of the cystic lesion. Only 1 patient who underwent chemotherapy remained clinically disease-free over 10 years after surgery. Chemotherapy regimens for osteosarcoma rather than those for soft tissue sarcoma are mostly effective for extraskeletal osteosarcoma, so the diagnosis by a biopsy is essential. It is important to consider extraskeletal osteosarcoma in the differential diagnosis of soft tissue tumor with cystic form and calcification and a long clinical course before consulting a doctor.

A case of primary extraskeletal osteosarcoma of the breast

BackgroundPrimary sarcomas of the breast are rare and account for less than 1% of all primary breast malignancies. We experienced a case of extraskeletal osteosarcoma of the breast that had a unique clinical course and remarkable findings of mammography and magnetic resonance imaging (MRI). A review of the case reports published in the past few decades showed no reports of a case in which a calcified lesion was followed up three different times on mammography, making this a valuable case report.Case presentationA 52-year-old woman noticed a right breast mass and underwent a breast examination. Mammography showed a 1.5-cm coarse calcified lesion in the upper outer portion of the right breast. Because fine-needle aspiration (FNA) revealed no suspicion of malignancy, she was followed up. Sixteen months later, the tumor grew progressively to 4.5 cm in size with new calcifications that were fine and irregular in shape and density surrounding an enlarged, coarse calcified lesion. Contrast-enhanced magnetic resonance imaging (MRI) showed a high signal intensity in the periphery of the tumor. Extirpation of the tumor was indicated. The pathological findings were extraskeletal osteosarcoma. She underwent additional resection and latissimus dorsi flap reconstruction at the Department of Orthopedic Surgery.ConclusionThe present case suggests that mammography findings of a tumor with coarse calcifications that are not typical of benign lesions may be extraskeletal osteosarcoma. A diagnosis must be made as early as possible in order to improve the prognosis of this disease.

Primary duodenal extraskeletal osteosarcoma-a case report

Abstract Extraskeletal osteosarcoma is a rare malignant soft tissue tumour, which represents about 4% of all osteosarcomas and 1% of all soft tissue sarcomas. We present a case of extraskeletal osteosarcoma, albeit at a hitherto

Navigation-assisted surgery for bone and soft tissue tumors with bony extension.

10073 Background: In recent times,minimally invasive surgery, such as endoscopic surgery, has gained a lot of popularity.The navigation system was introduced to orthopedic surgery in the 1990s. These days, computed tomography (CT)-based navigation systems are commonly used in spine and joint replacement surgery because of their precision. The aim of our study was to evaluate the accuracy and efficacy of navigation-assisted excision of bone and soft tissue tumors. Methods: From January 2006 to December 2009, we performed navigation-assisted surgery in 16 patients (11 men and 5 women; mean age, 39 years; range, 13-70 years). We diagnosed 9 benign bone tumors and 7 malignant bone and soft tissue tumors. In 2 patients, the malignant soft tissue tumors infiltrated the adjacent bones. We performed excisional biopsies for the benign tumors and en bloc excisions for the malignant tumors. In all the cases, the point registration method was used with 10 skin markers that were placed around the tumor. Each excisional difference between the preoperative and postoperative plans was evaluated histologically or by postoperative CT. Results: The mean preoperative registration matching time was 12.8 min (range, 8-25 min). The total mean preparation time was 24 min (range, 16-35 min). The mean accuracy of this system, which was determined using the skin markers, was 0.93 mm (range, 0.6-1.5 mm). All biopsied and excised specimens were evaluated by pathologic examination and postoperative CT imaging. The mean difference between the planned margin and postoperative CT or the excised histological specimen was 0 to 4 mm. The mean follow-up period was 53.2 months (range, 10-70 months). There were no local recurrences, except for a case of chordoma that required excision of skip metastases and a case of extraskeletal osteosarcoma, in which the patient died from the disease. Conclusions: We report our experience with navigation-assisted surgery for bone and soft tissue tumors performed using skin markers. Navigation-assisted surgery was indicated in the case of sufficiently reliable, accurate, and minimally invasive resections.

Subcutaneous extraskeletal osteosarcoma of the thigh with lymph node and lung metastasis: a case report

Background Extraskeletal osteosarcoma (ESOS) is a rare soft tissue tumour which accounts for approximately 1% of soft tissue sarcomas. In particular, subcutaneous osteosarcoma is extremely rare, occurring in less than 10% of ESOS cases. 1 Case report The case of a 71-year-old-woman with a 30-mm mass arising in the subcutaneous tissue of the thigh is presented. Radiological investigations showed spotty calcification in the mass without any attachment to the underlying bone. Wide surgical excision was performed. Microscopic examination revealed a pleomorphic spindle cell neoplasia with abnormal osteoid, some with ossification. It confirmed the diagnosis of subcutaneous ESOS with extension to the dermis and one lateral subcutaneous margin. Radiotherapy was commenced after a wide re-excision. Five months after the primary surgery, she developed metas-tases to the ipsilateral inguinal and pelvic lymph nodes and 5 months later she was diagnosed with inoperable pulmonary metastasis. Unfortunately she died 25 months after her first presentation. Discussion ESOS has been most often described in the deep soft tissues of the extremities. Subcutaneous tissue as a primary site is rare. This case emphasises the poor prognosis in patients with ESOS and the importance of aggressive treatment even in the cases with smaller size and more superficial location.

Osteosarcoma extraesquelético mesentérico primario: hallazgos en imagen

We present a case of extraskeletal osteosarcoma arising from the root of the mesentery. This location is extremely rare; to our knowledge only three other cases have been reported. We describe the findings at computed tomography, positron emission tomography, and bone scintigraphy. We emphasize the radiologic differential diagnosis in this case, which was complicated by the presence of other malignant abdominal disease.

Spontaneous Extraskeletal Osteosarcoma in the Stomach of an Aged F344 Rat

Extraskeletal osteosarcoma is a very rare tumor in humans and animals including rats. This paper describes a case of extraskeletal osteosarcoma observed in the glandular stomach of an aged female Fischer 344 rat. Grossly, a whitish solid mass was observed at the greater curvature of the glandular stomach. Histologically, the tumor consisted of both atypical polygonal and pleomorphic spindle-shaped cells, with pleomorphic nuclei, and it contained variable amounts of osteoids and small clumps of mature bone tissue. In addition, mitotic figures were frequently observed. Neither invasion of the muscle layer or vessels in the stomach nor metastasis to distant organs was detected. There were no skeletal tumors in the body. Immunohistochemically, the tumor cells were positive for osteocalcin, osteonectin, vimentin and S-100 protein. Judging from these results, the present tumor was diagnosed as extraskeletal osteosarcoma. This is the first report of spontaneous extraskeletal osteosarcoma arising from the stomach in a rat.

Cutaneous Metastasis of Extraskeletal Osteosarcoma Arising in the Mediastinum

Cutaneous metastases have been reported in 5%-10% of patients with internal malignancy. The most common clinical features are the sudden appearance of discrete, firm, and nontender nodules in a particular area of the body. The most frequent metastatic site of extraskeletal osteosarcoma (ESOS) is the lungs. Cutaneous metastasis of ESOS is rare. To our knowledge, only one case of ESOS has been reported with skin metastasis, histopathologically classified as the osteoblastic subtype. Here, we describe a case of chondroblastic ESOS arising in the mediastinum with metastasis to the skin. Our patient presented with a scalp nodule after diagnosis of primary ESOS at the mediastinum.

Extraskeletal Bone Sarcomas

Extraskeletal bone tumors are rare and high grade tumors including osteosarcoma, chondrosarcoma and Ewing's sarcoma of the soft tissues and its variants. A retrospective study of 25 cases of these tumors was made in our institution in the 1983 - 2000 period. The study of 25 cases revealed that these tumors affect adults (median age 51.2, range 17-73 years). The most common tumor locations were the thigh (12 cases, 48%) and the arm-elbow (6 cases, 24%). As a classification for diagnostic type of tumors: 14 were chondrosarcomas (56%), 8 were osteosarcomas (32%) and 3 were Ewing sarcomas (12%). The median follow-up was 47.07 months with a range from 24 months to 156 months. All the cases were treated with preop. chemotherapy and postoperative radiotherapy (with the exception of the myxoid chondrosarcoma). Globally, the preoperative duration of symptoms ranged from 2 weeks to 6 years (median 6 months). Local recurrences after wide and compartimental margin surgery developed in 7 cases (12%), three cases of chondrosarcoma and four cases of extraskeletal osteosarcoma; and distant metastases developed in seven cases (6 osteosarcomas and 1 Ewing's sarcoma). The two year overall survival rates were: extraeskeletal chondrosarcoma 50%, osteosarcoma 36.5% and Ewing sarcoma 66.6%. The two year disease-free survival was: 42.8% chondrosarcoma, 25% osteosarcoma and 33.3% Ewing sarcoma. The interest of this series is the fact that tumors are high grade and cure may be achieved by wide or compartimental local excision of the tumor at an early stage of the disease (combined with radiation and chemotherapy).

A case of extraskeletal osteosarcoma with metastasis in muscles

We present a case of a 78 year-old woman who was operated for mass of the left posterior chest. Histologically, the excised tumor was consistent with extraskeletal osteosarcoma. She was referred to the nuclear medicine department for a bone scan. The 99mTc -HDP scintigraphy exhibited multiple focal round areas of increased tracer uptake in soft tissue. This was proved to be multiple metastasis in muscles. imagenes de interes

A case of extraskeletal osteosarcoma with metastasis to the skin

We present an 83-year-old woman with extraskeletal osteosarcoma (ESOS) of the breast who developed metastasis to the scalp. Skeletal osteosarcoma is the most common primary malignant neoplasm of the bone, predominantly occurring in the metaphysis of the long bones of adolescents and young adults. ESOS, in contrast, occurs primarily in the fifth and sixth decades of life, most commonly in the soft tissue of the thigh. Although the lung is overwhelmingly the most common site of metastasis for both skeletal osteosarcoma and ESOS, the skin is an uncommon metastatic site with only a few reported cases. Metastasis of ESOS to the skin is an exceedingly infrequent phenomenon, which may be a sign of widespread metastases foreboding a grim prognosis. (J Am Acad Dermatol 2003;49:124-7.)

悪性線維性組織球腫を疑った骨外性骨肉腫の１例

A case of extraskeletal osteosarcoma, which has been suspected to be malignant fibrous histiocytoma, is reported. The patient was a 62-year old man. He noticed an asymptomatic nodule on his forehead 1 month before the first visit to our clinic. There were 5 firm nodules on his forehead. Wide excision of the lesions and skin grafting was performed. Biopsy specimens revealed dermal and subcutaneous infiltrating tumors without discernible borders, which were composed of spindle-like, histiocyte-like and osteoblast-like cells with pronounced nuclear atypia. In some areas, immature osteoid structures were also found. Immunohistochemical examination revealed that tumor cells react positively with actin, myosin, α1-antitrypsin, S-100 protein, and lysozyme. On the other hand, vimentin, CD34 and factor VIII were negative. Multiple matastatic lesions in the scalp were revealed with a CT scan and MRI. The right-sided hemiplegia was appeared and gradually increased. Therefore, the patient was treated only with anti-edema therapy. He died 3 months after the first visit to our clinic. Compared with osteosarcoma of bone, extraskeletal osteosarcoma is rare. There are 68 cases of this tumor recorded in the Japanese literature.

Extraskeletal Osteosarcoma: A Clinicopathologic Study of Four Cases

Four cases of extraskeletal osteosarcoma which were treated at the National Cancer Center Hospital have been reviewed. There were three males and one female. The ages of the patients were 32, 48, 48 and 59 years. Three patients had a solitary tumor located in the lower leg, thigh or postirradiated abdominal wall. The remaining patient had multiple tumors in the ipsilateral thigh and buttock. The predominant histologic subtype was osteoblastic in two cases, chondroblastic in one and malignant fibrous histiocytoma-like in one. Only one patient with a subcutaneous tumor was free of disease 16 years after a wide local excision without chemotherapy. The other three patients, two having undergone inadequate initial surgery, and one with multiple tumors, developed pulmonary metastases within 24 months of their initial surgical treatment. All of them died of the pulmonary metastases eight, 36 and 63 months after their initial treatment. Postoperative intensive chemotherapy was given to two patients. Although both had developed metastases to the lung, they received resection of the metastases combined with additional chemotherapy, surviving for more than 24 months after the occurrence of their first metastases.

Extraskeletal Osteosarcoma with Unusual Ultrastructural Features

A case of extraskeletal osteosarcoma was observed in the thigh of a 33-year-old male patient. Ultrastructurally the tumor was characterized by the presence of a particular dense type of cell, the nucleus of which showed a characteristic combination of features: large amounts of condensed marginated chromatin, prominent perichromatin granules, vermicellar bodies, and undulating microtubules. The tumor also contained intermediate-type cells with a more typical osteoblastic appearance, and more blastic cells. All three cell types contained varying amounts of dilated rough endoplasmic reticulum with prominent inclusions of crystalline material showing a hexagonal or banded pattern, indicating that the cells represent different stages of maturation rather than genuinely different types of cells. Dense cells showing the same characteristic combination of nuclear features have been described once before in a case of parosteal osteosarcoma. Our results indicate that these cells are a particular form of osteogenic cell. The presence of undulating microtubules and vermicellar bodies suggest a possible association with the presence of virus and/or increased levels of interferon.

Mediastinal osteosarcoma with extension to lungs in a patient treated for Hodgkin's disease

This article reports a patient with Hodgkin's disease in remission after combined modality therapy who developed metastatic pulmonary osteosarcoma, subsequently found to originate in soft tissue of the mediastinum, within a field irradiated 11 years previously. This patient developed a series of radiotherapy-induced complications in addition to osteosarcoma. Only 16 cases of extraskeletal osteosarcoma after radiation treatment have been reported, none originating in the mediastinum. To the authors' knowledge, this is the first reported case of extraskeletal osteosarcoma occurring in a patient previously treated for Hodgkin's disease and with the sarcoma originating within the irradiated field.