-
Acta Ortopedica Mexicana 2024conventional parosteal osteosarcoma is an uncommon malignant bone tumor, comprising 4% of all osteosarcomas. Although rare, parosteal osteosarcoma is the most common... (Review)
Review
INTRODUCTION
conventional parosteal osteosarcoma is an uncommon malignant bone tumor, comprising 4% of all osteosarcomas. Although rare, parosteal osteosarcoma is the most common type of osteosarcoma of the bone surface. We present the clinical, histological and imaging characteristics of a rare histologic variant of a parosteal osteosarcoma, review the literature and emphasize the importance of radio-pathological correlation as well as the interpretation of a representative biopsy in order to obtain the correct diagnosis.
CASE REPORT
a 36-year old woman began her condition one year prior to admission to the hospital with increased volume in the left knee and pain. Image studies showed a juxtacortical heterogeneous tumor localized on the posterior surface of the distal femoral metaphysis. An incisional biopsy was performed, with the diagnosis of a Parosteal Osteosarcoma and a wide surgical resection was undertaken. According to the findings of the surgical specimen, the diagnosis of a Parosteal Osteosarcoma with low grade chondrosarcoma and liposarcoma components was made. The knowledge of this rare parosteal osteosarcoma variant can lead the orthopedic oncologists to avoid overlooking the adipose component and provide adequate surgical margins.
CONCLUSION
we present the clinical, histological and imaging characteristics of a Parosteal Osteosarcoma with low grade liposarcoma and chondrosarcoma components.
Topics: Humans; Female; Adult; Liposarcoma; Chondrosarcoma; Osteosarcoma, Juxtacortical; Femoral Neoplasms; Bone Neoplasms
PubMed: 38782478
DOI: No ID Found -
Human Pathology May 2024There is no shortage of comprehensive review articles on bone and soft tissue pathology, almost always representing a regurgitation of the literature with little to no...
Keeping it real: Merging traditional and contemporary practices in musculoskeletal pathology: A special issue of neoplastic and non-neoplastic bone and soft tissue pathology.
There is no shortage of comprehensive review articles on bone and soft tissue pathology, almost always representing a regurgitation of the literature with little to no guidance on personal "best practices," recommended applications of ancillary testing, and alternative points of view. This special issue of Human Pathology uniquely unites evidence-based medicine, where appropriate, with the collective personal experiences of a wide range of accomplished pathologists from varying institutions and backgrounds, addressing problematic areas, updated and sometimes imperfect classification systems, and their personal preferences for cost-effectively incorporating ancillary testing. For the preponderance of general pathologists (and specialists), whether academic or non-academic, non-neoplastic musculoskeletal diseases represent a far higher percentage of their practice than bone and soft tissue neoplasia. One of the most common frozen sections performed at many hospitals throughout the USA is revision arthroplasty, relying on the pathologist to help determine the presence (or absence) of periprosthetic joint infection, largely based on the hematoxylin & eosin (H&E) slide. Not every institution has access to the latest molecular techniques; fortunately, many of the current immunohistochemical antibodies serve as reliable surrogate markers of genetic mutations, allowing for cheaper but accurate diagnoses, when deemed necessary. Furthermore, molecular testing is often not necessary to establish a specific diagnosis, even among neoplasms with known underlying genetic abnormalities. It must be remembered that most bone and soft tissue tumors were recognized and classified correctly, before we uncovered and understood, among a subset, their underlying and unique molecular aberrations. Perhaps not surprisingly, in some cases, more than one molecular pathway may lead to the same histologic tumor subtype. Less commonly, an identical genetic driver/fusion may result in immunophenotypically and biologically distinct neoplasms, sometimes with entirely different clinical behaviors. "Dedifferentiation," a concept recognized among a variety of bone and soft tissue neoplasms, including but not limited to chondrosarcoma, parosteal osteosarcoma, and liposarcoma, needs to be objectively reassessed, particularly for liposarcoma. The following reviews attempt to address the above concepts, re-emphasizing the important role the practicing pathologist continues to (and must) play in the differential diagnoses of neoplastic and non-neoplastic musculoskeletal diseases.
Topics: Humans; Bone Neoplasms; Soft Tissue Neoplasms; Musculoskeletal Diseases; Predictive Value of Tests
PubMed: 38556003
DOI: 10.1016/j.humpath.2024.03.007 -
Indian Journal of Surgical Oncology Mar 2024This study aimed to evaluate the significance of radiological (magnetic resonance imaging [MRI]) findings, surgical, and previous interventions on prognosis with...
This study aimed to evaluate the significance of radiological (magnetic resonance imaging [MRI]) findings, surgical, and previous interventions on prognosis with oncological and functional outcome in patients with parosteal osteosarcoma (POS). Twenty-seven patients (8 male/19 female) who were operated with the diagnosis of primary POS in our institution were retrospectively reviewed. The epidemiological data, biopsy method, misdiagnosis/improper interventions, and delay in diagnosis were noted. The lesions' maximum circumferential extension, maximum longitudinal extension, intramedullary involvement, and neurovascular extensions in MRI sections were evaluated, and the resection type (segmental intraarticular/segmental intercalary/hemicortical), reconstruction type (biologic/non-biologic), and surgical margins were noted. Functional and oncological results at the last follow-up were assessed. The mean age was 31.6 (12-73) years, and mean follow-up was 80.8 (24-270) months. Intramedullary involvement percentage was related with maximum circumferential extension percentage and maximum longitudinal extension. ( = 0.006, = 0.005) The intramedullary involvement ratio of ≤ 10% suggested no recurrence or metastasis. The neurovascular encasement was related to metastatic disease, deep infections, and complication related surgeries ( = 0.017, = 0.002, = 0.005). The most common resection type was segmental intraarticular resection (63%). The maximum circumferential extension percentage, the maximum longitudinal extension of the lesion, intramedullary involvement percentage, and neurovascular encasement had lower MSTS scores ( = 0.003, = 0.028, = 0.038, = 0.022). The mean MSTS score was 81.1% (60-100%). The 5-year overall survival was 96.3%, local recurrence-free survival was 77.2%, and metastasis-free survival was 69.4%. The lesions' extent of intramedullary involvement, neurovascular bundle proximity, and maximum periosteal circumferential extension on MRI should be considered when planning the surgery.
PubMed: 38545575
DOI: 10.1007/s13193-022-01670-z -
Human Pathology May 2024Dedifferentiation traditionally is defined by descriptive criteria as a tumor showing an abrupt change in histology from a conventional, classic, low-grade appearing... (Review)
Review
Dedifferentiation traditionally is defined by descriptive criteria as a tumor showing an abrupt change in histology from a conventional, classic, low-grade appearing neoplasm to a tumor that is more cellular, pleomorphic and "high grade", with grading typically being performed by subjective criteria. The dedifferentiated areas range from areas with recognizable histologic differentiation which differs from the primary tumor (such as an osteosarcoma arising from a low-grade chondrosarcoma) to areas containing sarcomas without specific histologic differentiation (such as pleomorphic or spindle cell sarcoma). Many, but not all, dedifferentiated tumors are aggressive and associated with significantly shorter survival than their conventional counterparts, even grade 3 conventional tumors. As a result, dedifferentiated tumors are generally considered to be clinically aggressive and as a result, more aggressive surgery or the addition of (neo)adjuvant chemotherapy is often considered. However, long-term (greater than 20 year) survivors are reported in the most common dedifferentiated bone and soft tissue sarcomas. Moreover, use of mitotic criterion for defining dedifferentiation in dedifferentiated liposarcoma as well as grading (by the French system) have been found to be associated with survival. This paper reviews the literature on dedifferentiated chondrosarcoma, dedifferentiated liposarcoma, dedifferentiated chordoma and dedifferentiated parosteal osteosarcoma. As a result of that review, recommendations are advocated to identify evidence-based, objective diagnostic and grading criteria for dedifferentiation that are appropriate for each tumor type. Adding such criteria will improve consistency in diagnosis worldwide, allow easier comparison of clinical research performed on dedifferentiated tumors and help communicate (to patients and clinicians) the tumors with highest risk of clinically aggressive behavior, to allow appropriate and personalized treatment planning.
Topics: Humans; Cell Dedifferentiation; Bone Neoplasms; Sarcoma; Neoplasm Grading; Soft Tissue Neoplasms; Chondrosarcoma; Prognosis; Osteosarcoma; Liposarcoma
PubMed: 38311185
DOI: 10.1016/j.humpath.2024.02.001 -
Musculoskeletal Surgery May 2024Dedifferentiated low-grade osteosarcomas, which are considered high grade malignancies, can arise from the dedifferentiation of parosteal and low-grade osteosarcomas.... (Review)
Review
PURPOSE
Dedifferentiated low-grade osteosarcomas, which are considered high grade malignancies, can arise from the dedifferentiation of parosteal and low-grade osteosarcomas. Usually, localized dedifferentiated low-grade osteosarcomas are treated by wide resection, and the efficacy of adjuvant chemotherapy is controversial. We conducted a systematic review of studies that investigated the rates of mortality and significant events, such as recurrence and metastases, in localized dedifferentiated low-grade osteosarcoma patients who received wide resection only and in those who received wide resection and (neo-)adjuvant chemotherapy.
METHODS
We identified 712 studies through systematic searches of Embase, PubMed, and the Cochrane Central Register of Controlled Trials databases. Of those studies, seven were included in this review and none were randomized controlled trials. In the seven studies, 114 localized dedifferentiated low-grade osteosarcoma patients were examined.
RESULTS
Mortality rates of the resection plus chemotherapy (R + C) and the resection only (Ronly) groups were 20.3% and 11.4%, respectively [overall pooled odds ratio, 1.59 (P = 0.662); heterogeneity I, 0%]. The local recurrence or distant metastasis rate in the R + C group was 36.7% and that in the Ronly group was 28.6% [overall pooled odds ratio, 1.37 (P = 0.484); heterogeneity I was 0%].
CONCLUSIONS
Results show a limited efficacy of adjuvant chemotherapy for localized dedifferentiated low-grade osteosarcoma. However, because this was a systematic review of retrospective studies that examined a small number of patients, future randomized controlled trials are needed.
PubMed: 38709428
DOI: 10.1007/s12306-024-00821-5 -
Acta Ortopedica Mexicana 2023parosteal osteosarcoma is an extramedullary malignant bone tumor in which cells produce osteoid, represents less than 5% of all osteosarcomas, it occurs predominantly in...
INTRODUCTION
parosteal osteosarcoma is an extramedullary malignant bone tumor in which cells produce osteoid, represents less than 5% of all osteosarcomas, it occurs predominantly in women between the second and fourth decade of life. It is often located in the distal region of the femur and proximal tibia. Clinically it presents with increased volume and thigh or knee pain. Due to its low incidence and clinical features, a clinical case of femoral parosteal osteosarcoma is presented, with description of the surgical technique performed.
CASE REPORT
a 14-year-old female presented with a 6-month history of increased volume and right thigh pain. Radiological studies revealed a bone lesion with malignant characteristics, for which she was sent to third-level hospital where oncology study protocol was set up; consisting in two percutaneous biopsies of the lesion with Jamshidi needle, which were histopathology reported as negative for malignant cells. The pulmonary high-resolution computed tomography showed metastasis and a Tc-99m MDP bone scintigraphy showed increased osteoblastic activity in the right femoral shaft. Given the results, is confirmed the need of en-bloc resection and intercalary prosthesis implantation with adjuvant chemotherapy.
CONCLUSION
the intercalary prosthesis is a suitable therapeutic option in limb-salvage surgery for patients with femoral parosteal osteosarcoma.
Topics: Humans; Female; Adolescent; Femur; Prosthesis Implantation; Bone Neoplasms; Osteosarcoma, Juxtacortical; Osteosarcoma; Artificial Limbs; Limb Salvage; Pain
PubMed: 38382457
DOI: No ID Found -
Radiology Case Reports Oct 2023Parosteal osteosarcomas (POS) are well-differentiated low-grade malignant sarcomas that are located on the surface of the bone. POS of the temporal bone is exceptionally...
Parosteal osteosarcomas (POS) are well-differentiated low-grade malignant sarcomas that are located on the surface of the bone. POS of the temporal bone is exceptionally rare, with less than a hand full of cases present in modern literature. Here, we report a POS of the temporal bone found incidentally and with an uncharacteristic presentation. We also review the unique imaging and histopathological findings of this entity and discuss why developing a broad differential diagnosis and proceeding with early intervention are considered imperative in this disease.
PubMed: 37577081
DOI: 10.1016/j.radcr.2023.07.038 -
BMC Cancer Jun 2024Immunodeficient murine models are usually used as the preclinical models of osteosarcoma. Such models do not effectively simulate the process of tumorigenesis and...
Immunodeficient murine models are usually used as the preclinical models of osteosarcoma. Such models do not effectively simulate the process of tumorigenesis and metastasis. Establishing a suitable animal model for understanding the mechanism of osteosarcoma and the clinical translation is indispensable. The UMR-106 cell suspension was injected into the marrow cavity of Balb/C nude mice. Tumor masses were harvested from nude mice and sectioned. The tumor fragments were transplanted into the marrow cavities of SD rats immunosuppressed with cyclosporine A. Through muti-rounds selection in SD rats, we constructed orthotopic osteosarcoma animal models using rats with intact immune systems. The primary tumor cells were cultured in-vitro to obtain the immune-tolerant cell line. VX2 tumor fragments were transplanted into the distal femur and parosteal radius of New Zealand white rabbit to construct orthotopic osteosarcoma animal models in rabbits. The rate of tumor formation in SD rats (P1 generation) was 30%. After four rounds of selection and six rounds of acclimatization in SD rats with intact immune systems, we obtained immune-tolerant cell lines and established the orthotopic osteosarcoma model of the distal femur in SD rats. Micro-CT images confirmed tumor-driven osteolysis and the bone destruction process. Moreover, the orthotopic model was also established in New Zealand white rabbits by implanting VX2 tumor fragments into rabbit radii and femurs. We constructed orthotopic osteosarcoma animal models in rats with intact immune systems through muti-rounds in-vivo selection and the rabbit osteosarcoma model.
Topics: Animals; Osteosarcoma; Rabbits; Rats; Disease Models, Animal; Bone Neoplasms; Cell Line, Tumor; Mice; Mice, Nude; Rats, Sprague-Dawley; X-Ray Microtomography; Mice, Inbred BALB C; Immunocompetence; Humans; Neoplasm Transplantation; Femur; Male
PubMed: 38849717
DOI: 10.1186/s12885-024-12361-z