OsteosarcomaDR: Gehan mohamed

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04/19/23 2

Osteosarcoma

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Definition

Osteosarcoma is an aggressive malignant neoplasm arising from primitive transformed cells of mesenchymal origin (and thus a sarcoma) that exhibit osteoblastic differentiation and produce malignant osteoid.

It is the most common histological form of primary bone cancer in age 12-25yrs.

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Epidemiology

Male more than female

at any age but

75% of cases appear at age 12-25yrs

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Risk factors:

Radiation exposure

Patients who survive after taking therapy for another Cancer.

Retinoblastoma(malignant tumor arising from retina of eye).

Sites of predlection:

Osteosarcoma :It originates more frequently in the metaphyseal region of tubular long bones, with 42% occurring in the femur

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Skeletal distribution : most common at Knee region

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osteosarcoma

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Histopathologic variants1. Conventional: osteoblastic, chondroblastic, fibroblastic

2. Multifocal

3. Telangiectatic

4. Small cell

5. Intraosseous well-differentiated

6. Intracortical

7. Periosteal

8. Paraosteal

9. High-grade surface

10. Extraosseous

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Diagnosis of osteosarcoma

Clinical examiation

Radiologic examinatiom

Biopsy for histopathology

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Clinical Presentation

Painful mass arising from bone

Metastasize early

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Plain Xray

The area of tumor mass may be Lytic, sclerotic or mixed

In x – ray we can see Codman triangle

Codman triangle is a term used to describe the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone.

sun-burst" appearance on X-ray examination due to the tumor spicules of calcified bone radiating in right angles

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Codman triangle

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Codman triangle

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Local

CT

MRI

+/- Angiogram

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Systemic

Bone scan

CT Chest

Osteosarcoma : it is formed of Spindle shaped cells showing malignant criteria in form of pleomorphism,hyperchromasia, abnormal mitosis, giant cells . In

between spindle cells there is malignant osteoid.

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Differential Dx

Giant Cell Tumor

Aneursymal Bone Cyst

Ewings tumor

Osteoblastoma

Metastasis

Lymphoma