UoB: 07029511

Chondroblsatic Osteosarcoma

A case Study

Objectives:

• To critically analyze the value of each imaging examination in the management and diagnosis of a patient who presented symptomatically.

• To discuses the decision making process in the patient imaging pathways for the diagnosis and the management of the patient.

Confidentiality

• Anonymisation

• Patient’s consent to disclosing the information

• Only necessary information

• The Confidentiality model

(Confidentiality: NHS Code of Practice 2003)

Presenting Complaints

• Fifteen years old male patient • Swelling in posterior region of the scalp• Outside diagnosis was osteosarcoma,• Primary lesion in skull• Disease recurrence

Clinical History

• Patient underwent surgery in September 2009• Excision of the mass done• No histopathology of the of the excised mass was

performed. • Another open excision biopsy was done on local

recurrence of the disease.• This time histopathology was performed• Diagnosis was osteosarcoma.

Diagnostic Tests

• Different diagnostic tests were ordered to confirm the diagnosis

• These tests includes CT head, chest radiography, and bone scintigraphy

• Pathology slides of the biopsy sample were reviewed by an oncology pathologist

Results of the diagnostic tests

Diagnostic tests Results

Chest Radiograph Clear

CT Head Appearances remain suspicious for residual tumour

Bone scintigraphy Bony pathology at occipital bone.

-ive for metastases

Review of Pathology slides

Suggestive of chondroblastic osteosarcoma

CT Head

Diagnosis

• Confirmed Chondrblastic Osteosarcoma

• Primary lesion in skull

Staging and toxicity workup

• Different imaging and pathology test

• Which includes

• CT thorax

• MRI Brain

• MUGA

• Creatinine Clearance

• Baseline organ function tests

Results of the test

Tests Results

CT Thorax Normal

MRI Brain Predominantly large extra cranial occipital mass.

Small intracranial extradural enhancement.

Skull Radiographs Soft tissue swelling in occiput

Periosteal reaction in outer-table dominantly

MUGA LVEF = 68%.

Cont…

Pathology Tests Results

Baseline organ function tests

Within normal limits

Creatinine clearance Slightly raised * 131 ml/min

Patient Management

• Chemotherapy was planned due to classically resistant nature of the tumour towards radiotherapy

• Surgery was considered as an option

• Orthopaedic surgeon’s opinion

• Discussed in multidisciplinary meeting

Multidisciplinary teams

• Multidisciplinary team meetings play a very significant role in patient management

• Patient was presented into

sarcoma MDT meeting

• later, he was presented in Neurology MDT meeting to decide patient management

Justification of imaging studies

• Role of the imaging modalities– Diagnostic workup– Staging and toxicity workup

• Advantages

• Drawbacks

• Impact on patient management

• As Low As reasonably Practicable (IRMR, 2000)

Plain film Radiography

• To establish the diagnosis

• Facilitate to narrow down the differential diagnosis

• Location of the bone

• New bone formation

CT Thorax and CT head

• Important to detect micro lesion

• Easily detect the lesions less than three centimetres

• Retrocardial nodule can not be missed

• Cross sectional imaging provides

CT Head

• Advantage

MRI Brain

References:

• Confidentiality: NHS Code of Practice (2003)

• (IRMR, 2000)

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