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Journal of Surgical Oncology Sep 2021The subtypes of surface osteosarcomas include well-differentiated, low-grade parosteal osteosarcoma (POS), intermediate-grade periosteal osteosarcoma (PerOS), high-grade...
BACKGROUND AND OBJECTIVES
The subtypes of surface osteosarcomas include well-differentiated, low-grade parosteal osteosarcoma (POS), intermediate-grade periosteal osteosarcoma (PerOS), high-grade surface osteosarcoma (HGSO), and high-grade, dedifferentiated POS (dPOS). We aimed to determine disease progression, defined as local recurrence and metastatic disease, and overall (OS) and disease-specific survival (DSS). We identify outcome predictive factors and report functional results.
METHODS
This retrospective study evaluated patients with primary surface osteosarcoma at our hospital from 1992 to 2019. Fifty-one patients had a median follow-up of 6.1 years (range: 0.1-25.2). Histologic subtypes included 32 POS, 11 PerOS, 4 HGSO, and 3 dPOS. Bone and soft tissue margins were classified using the American Joint Committee on Cancer residual tumor classification (Rx = Not evaluable; R0 = negative margin; R1 = microscopic positive margin; and R2 = macroscopic positive margin) and the modified R classification (mRx = not evaluable; mR0 = negative margin >1 mm; mR1 = negative margin ≤1 mm; mR1-dir: Positive microscopic margin locally; mR2a: Positive macroscopic margin locally; mR2b: positive macroscopic margin distally; and mR2C: positive macroscopic margin locally and distally). Forty-one patients had functional outcomes.
RESULTS
Three POS patients developed recurrence: two had R0 margins and one an intralesional resection. Five patients developed lung metastases (POS: 3, dPOS: 2). Four patients died. The only significant disease progression predictor was age. OS at 10 years was 97%. 48 patients had negative bone margins (R0 or mR0 and mR1) and 47 patients had negative soft-tissue margins (R0 or mR0 and mR1). The average MSTS score was 88.43 (range: 34.29-100).
CONCLUSIONS
We advocate surgery for POS and believe R0 (mR0 and mR1 resections) or planned R1 (mR1-dir) to preserve function are acceptable. We favor chemotherapy and surgery for PerOS, though a chemotherapeutic response is highly variable. High-grade tumors are the most infrequent subtype, but HGSO and dPOS seem to portend a poorer prognosis. Good function can be obtained.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Female; Follow-Up Studies; Humans; Limb Salvage; Lymphatic Metastasis; Male; Margins of Excision; Middle Aged; Neoplasm Recurrence, Local; Osteosarcoma; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Time Factors; Young Adult
PubMed: 34043244
DOI: 10.1002/jso.26531 -
Journal of Cancer Research and... 2018With the exception of multiple myelomas, osteosarcoma is the most frequently occurring primary malignant bone tumor with an overall incidence of 1:100,000/year. It has...
With the exception of multiple myelomas, osteosarcoma is the most frequently occurring primary malignant bone tumor with an overall incidence of 1:100,000/year. It has greatest predilection for the metaphyses, most frequently femur and tibia. However, osteosarcomas affecting the craniofacial bones are infrequent. Two main types: intramedullary and juxtacortical varieties are seen. Juxtacortical variety is further subdivided into periosteal and parosteal variants. Due to its rarity, only 13 cases of parosteal osteosarcoma have been reported till date. A 35-year-old male patient with affected postirradiated mandible is being reported as the 14 case of this kind with its unique benign presentation and less aggressive nature.
Topics: Adult; Biopsy; Bone Neoplasms; Humans; Male; Mandible; Osteosarcoma, Juxtacortical; Radiography; Tomography, X-Ray Computed
PubMed: 29516945
DOI: 10.4103/0973-1482.176420 -
Medicine Jan 2019Parosteal osteosarcoma (PO) is relatively rare, accounting for about 1% of primary malignant bone tumors and 4% of all osteosarcomas. Onset is generally at approximately...
RATIONALE
Parosteal osteosarcoma (PO) is relatively rare, accounting for about 1% of primary malignant bone tumors and 4% of all osteosarcomas. Onset is generally at approximately 20 to 40 years of age; the distal posterior surface of femur is the most common site, accounting for more than 60% cases. However, PO in middle-aged or elderly patients is extremely rare and PO occurring in the fibula is even rarer. To our knowledge, this is the first case of PO occurring in the fibula of a middle-aged adult.
PATIENT CONCERNS
We present a case of a 47-year-old female who had a lateral mass on her left knee for 3 months with no obvious cause.
DIAGNOSES
The patient was initially diagnosed with a proximal left fibula tumor via x-ray scan at a local hospital. Subsequently, osteochondroma was highly suspected through computed tomography (CT) and magnetic resonance imaging (MRI) obtained at our hospital. Finally, the postoperative pathological report confirmed PO.
INTERVENTIONS
She underwent a complete resection of the left fibula tumor and received postoperative adjuvant chemotherapy.
OUTCOMES
The patient recovered well and was discharged on the 10th day after admission. Additionally, there was no evidence of recurrence at the 4-year follow-up after surgery.
LESSONS
In middle-aged or elderly patients, early diagnosis of PO in the fibula is difficult and misdiagnosis or missed diagnosis is common. In clinical practice, PO is uncommon in middle-aged or elderly patients, occurs more rarely in the peroneal bone, and should be carefully identified. CT and MRI are essential for diagnosis, with pathological examination being effective for confirmation. Because of the limited reports of PO of the fibula in middle-aged or elderly adults, the present case raises awareness of this rare condition.
Topics: Bone Neoplasms; Diagnosis, Differential; Female; Fibula; Humans; Middle Aged; Osteosarcoma
PubMed: 30633158
DOI: 10.1097/MD.0000000000013857 -
Journal of Korean Medical Science Oct 1999Parosteal osteosarcoma is a low-grade osteosarcoma, which occurs on the surface of the bone. We had experienced a parosteal osteosarcoma involving the flat bone, the...
Parosteal osteosarcoma is a low-grade osteosarcoma, which occurs on the surface of the bone. We had experienced a parosteal osteosarcoma involving the flat bone, the scapula of a 21-year-old man. This is an extremely rare location for a parosteal osteosarcoma. Plain radiograph showed broad-based, well-defined radiodense lesion at the scapula. Computed tomogram demonstrated an intact cortex and absence of a medullary involvement. Tumor showed a lobulated, high-density lesion, indicating bone formation. Histologically, parosteal osteosarcoma is a well-differentiated osteosarcoma. The tumor is composed of a hypocellular proliferation of spindle cells, with minimal cytologic atypia. The bone is in the form of a well-formed bony trabeculae. Occasional cartilage is present in the form of a cap.
Topics: Adult; Bone Neoplasms; Humans; Male; Osteosarcoma; Scapula; Tomography, X-Ray Computed
PubMed: 10576159
DOI: 10.3346/jkms.1999.14.5.586 -
Skeletal Radiology Oct 2000A unique case of parosteal osteosarcoma (POS) of the proximal femur, with areas of telangiectatic dedifferentiation, in a 28-year-old woman is reported. The patient had... (Review)
Review
A unique case of parosteal osteosarcoma (POS) of the proximal femur, with areas of telangiectatic dedifferentiation, in a 28-year-old woman is reported. The patient had a 7-week history of pain and swelling in her right thigh. A biopsy diagnosis of POS was established. The patient was treated with two cycles of intraarterial chemotherapy, followed by limb salvage surgery. Histological examination of the resected specimen showed POS with areas of dedifferentiation composed of highgrade telangiectatic osteosarcoma with associated secondary aneurysmal bone cyst change.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Cysts, Aneurysmal; Female; Femoral Neoplasms; Femur; Humans; Infusions, Intra-Arterial; Magnetic Resonance Imaging; Osteosarcoma; Osteosarcoma, Juxtacortical
PubMed: 11127684
DOI: 10.1007/s002560000247 -
Acta Ortopedica Brasileira 2022Evaluate risk factors related to clinical evolution and dedifferentiation of parosteal (juxtacortical) osteosarcoma to high-grade osteosarcoma.
OBJECTIVE
Evaluate risk factors related to clinical evolution and dedifferentiation of parosteal (juxtacortical) osteosarcoma to high-grade osteosarcoma.
METHODS
Retrospective cohort study performed over a period of 25 years, using data from medical records of patients diagnosed with parosteal osteosarcoma. The data were submitted to statistical analysis by Fisher's exact test and Student's t-test.
RESULTS
Of the 326 patients treated for osteosarcoma, we identified 17 patients diagnosed with parosteal osteosarcoma. Of these, 4 (23.5%) were not actually diagnosed with parosteal osteosarcoma and 4 did not have the minimum data required for analysis, being excluded from the study. Of the 9 patients studied, we observed that 3 (33.3%) evolved with tumor dedifferentiation to high-grade osteosarcoma. Moreover, 2 (66.7%) had local recurrence and 2 (66.7%) metastases.
CONCLUSION
Age, sex, and the tumor size were not directly related to the dedifferentiation from parosteal osteosarcoma to high-grade osteosarcoma. The most aggressive clinical evolution - presence of local recurrences and metastasis - in parosteal osteosarcoma occurred in tumors with dedifferentiation, however, we cannot associate each other as cause and effect, but as related factors.
PubMed: 36451789
DOI: 10.1590/1413-785220223005e257493 -
BMC Musculoskeletal Disorders Dec 2023Parosteal osteosarcomas are low-grade bony malignancies that are treated primarily with surgical resection and reconstruction. This report discusses a unique case of a...
INTRODUCTION
Parosteal osteosarcomas are low-grade bony malignancies that are treated primarily with surgical resection and reconstruction. This report discusses a unique case of a pediatric patient who presented with a parosteal osteosarcoma of the distal radius causing extensive erosive mass effect and growth disturbance of the adjacent ulna. Likely due to their slow-growing nonaggressive nature, parosteal osteosarcomas have not been previously described to abut adjacent bony structures through direct contact. The patient presented in a significantly delayed manner due to social circumstances, inadvertently revealing this novel behavior. This report reviews this rare case and describes the current understanding of this tumor.
CASE PRESENTATION
The patient is a 13-year-old male who presented with a parosteal osteosarcoma of his distal radius. He presented with a palpable wrist mass and wrist stiffness. He presented in a delayed manner with advanced local disease due to social factors. Imaging revealed an osseous radial mass that abutted the ulna and likely stunted its growth. The patient ultimately underwent complex resection and allograft reconstruction of both his distal radius and ulna. Intraoperative pathology was confirmed to have negative tumor margins. Allograft reconstruction of the radius and ulna was performed utilizing patient-specific custom cutting guides. At the 6-month postoperative visit, the patient had no recurrence of the mass, minimal pain, and had almost regained range of motion of the extremities. Clinical radiographs at the 6-month postoperative visit demonstrated allograft incorporation.
CONCLUSIONS
A previously unreported case of pediatric parosteal osteosarcoma of the distal radius with erosion of the adjacent ulna through direct contact is presented. The challenges in and the importance of arriving at a definitive diagnosis in a timely manner for the proper treatment of this malignancy are emphasized.
Topics: Adolescent; Humans; Male; Bone Neoplasms; Osteosarcoma; Radius; Ulna; Upper Extremity
PubMed: 38057715
DOI: 10.1186/s12891-023-07018-0 -
Journal of the National Medical... Jan 1991We report on the case of a 24-year-old black male who presented to the orthopedic service with a parosteal osteosarcoma of the distal tibia. There have been 206 cases...
We report on the case of a 24-year-old black male who presented to the orthopedic service with a parosteal osteosarcoma of the distal tibia. There have been 206 cases reported on this tumor in all the world's literature, with the distal femur being the most common location; this case report is rare, therefore, because of the unusual location of the tumor. This article was prepared in order to familiarize the general medical community with the occurrence of the tumor and to provide some general background information and treatment recommendations for parosteal osteosarcoma.
Topics: Adult; Bone Neoplasms; Humans; Male; Osteosarcoma; Radiography; Tibia
PubMed: 1994072
DOI: No ID Found -
Skeletal Radiology Oct 1998Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm which varies in the amount of bone tissue laid down. We report on a case of OFMT in a 59-year-old male... (Review)
Review
Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm which varies in the amount of bone tissue laid down. We report on a case of OFMT in a 59-year-old male which mimicked a large parosteal osteosarcoma on radiography, MRI, and CT. T1-weighted MR images showed high-intensity areas which reflected fatty marrow. The metaplastic bone was connected to the cortex of the femur, but the tumor did not involve the medullary cavity. The tumor was irradiated and the patient was administered chemotherapy. Wide excision of the tumor and hip rotation plasty was performed. The patient has been disease free for 18 months.
Topics: Bone Neoplasms; Chronic Disease; Combined Modality Therapy; Contrast Media; Diagnosis, Differential; Femur; Fibroma, Ossifying; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteosarcoma, Juxtacortical; Tomography, X-Ray Computed
PubMed: 9840396
DOI: 10.1007/s002560050441 -
The Journal of Bone and Joint Surgery.... Mar 1994The records of 226 patients (sixty-seven who were managed at our institution and 159 who were identified from the consultation files) who had had a parosteal...
The records of 226 patients (sixty-seven who were managed at our institution and 159 who were identified from the consultation files) who had had a parosteal osteosarcoma were reviewed. The criteria for diagnosis were that, roentgenographically, the lesion had arisen from the surface of the bone and that, histologically, the tumor was well differentiated (Grade 1 or 2); it was characterized by well formed osteoid within a spindle-cell stroma; and, when there was medullary involvement, less than 25 per cent of the medullary cavity was affected. Dedifferentiation was more common (16 per cent of the patients) than previously reported and was associated with a poor prognosis. Cross-sectional imaging studies demonstrated medullary involvement in 22 per cent of the patients, an unmineralized soft-tissue mass peripheral to the mineral component in 51 per cent, and adjacent soft-tissue invasion in 46 per cent. In contrast to the findings in our previous studies, medullary involvement was not a poor prognostic factor. At an average of thirteen years (range, two to forty-one years), eleven of the sixty-seven patients who were managed at our institution died of the tumor; ten of these patients had a dedifferentiated tumor. Statistical analysis of the thirty-nine patients who had had the primary treatment at our institution revealed that incomplete resection was associated with an increased risk of local recurrence and that dedifferentiation markedly increased the risk of metastasis.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Cell Differentiation; Child; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Recurrence, Local; Osteosarcoma, Juxtacortical; Prognosis; Risk Factors; Survival Analysis; Survival Rate
PubMed: 8126042
DOI: 10.2106/00004623-199403000-00007