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The Journal of International Advanced... Oct 2023Osteosarcoma is the most common primary malignant tumor affecting the bone but is a rare occurrence in the head and neck region. Complete surgical resection with wide...
Osteosarcoma is the most common primary malignant tumor affecting the bone but is a rare occurrence in the head and neck region. Complete surgical resection with wide surgical margins is currently the main treatment strategy for osteosarcoma but can be hard to achieve due to the complex anatomy of the head and neck. We report the first case of primary high-grade dedifferentiated parosteal osteosarcoma arising from the temporal bone in published literature. The 19-year-old patient presented with a left retroauricular lesion measuring 3 cm in diameter. Radiographic imaging and biopsy suggested the diagnosis of intermediate-grade chondrosarcoma, but definitive histopathology confirmed a diagnosis of dedifferentiated parosteal osteosarcoma. The tumor was resected with wide margins, removing the underlying temporal bone, periosteum and overlying soft tissue through a lateral temporal bone resection. The middle ear was reconstructed with cartilage grafting, and the dura of the posterior and middle cranial fossa was covered using temporal fascia grafts and local transpositional flaps. The patient is recurrence free 10 months after treatment. This report was assembled following CARE [The CARE guidelines (for Case Reports)] guidelines and describes clinical, histological, and radiological manifestations of our patient's rare clinical entity and may provide more data in treating patients with osteosarcoma affecting the anatomically complex head-and-neck region.
Topics: Humans; Young Adult; Adult; Bone Neoplasms; Osteosarcoma; Osteosarcoma, Juxtacortical; Tomography, X-Ray Computed; Temporal Bone
PubMed: 37789632
DOI: 10.5152/iao.2023.22923 -
Skeletal Radiology Jul 2009This study was performed to assess the imaging findings in cases of parosteal osteosarcoma dedifferentiated into telangiectatic osteosarcoma. Parosteal osteosarcoma is a...
PURPOSE
This study was performed to assess the imaging findings in cases of parosteal osteosarcoma dedifferentiated into telangiectatic osteosarcoma. Parosteal osteosarcoma is a low-grade well-differentiated malignant tumor. Dedifferentiation into a more aggressive lesion is frequent and usually visible on imaging as a central lytic area in a sclerotic mass. Only one case of differentiation into a telangiectatic osteosarcoma has been reported. As it has practical consequences, with a need for aggressive chemotherapy, we looked for this rather typical imaging pattern.
MATERIALS AND METHODS
Review of 199 cases of surface osteosarcomas (including 86 parosteal, of which 23 were dedifferentiated) revealed lesions suggesting a possible telangiectatic osteosarcoma on imaging examinations in five cases (cavities with fluid). Histology confirmed three cases (the two other only had hematoma inside a dedifferentiated tumor). There were three males, aged 24, 28, and 32. They had radiographs and CT, and two an MR examination.
RESULTS
Lesions involved the distal femur, proximal tibia, and proximal humerus. The parosteal osteosarcoma was a sclerotic, regular mass, attached to the cortex. A purely lytic mass, partially composed of fluid cavities was easily detected on CT and MR. It involved the medullary cavity twice, and remained outside the bone once. Histology confirmed the two components in each case. Two patients died of pulmonary metastases and one is alive.
CONCLUSION
Knowledge of this highly suggestive pattern should help guide the initial biopsy to diagnose the two components of the tumor, and guide aggressive treatment.
Topics: Adult; Bone Neoplasms; Cell Differentiation; Femoral Neoplasms; Humans; Male; Osteosarcoma; Telangiectasis; Tomography, X-Ray Computed; Young Adult
PubMed: 19271217
DOI: 10.1007/s00256-009-0672-3 -
Clinical Sarcoma Research Jul 2011Parosteal osteosarcoma is a well-differentiated variant of osteosarcoma that affects the surface of the bone. The imaging pattern is very typical. We report two cases...
BACKGROUND
Parosteal osteosarcoma is a well-differentiated variant of osteosarcoma that affects the surface of the bone. The imaging pattern is very typical. We report two cases mimicking an osteochondroma, radiologically and histologically and propose an explanation.
METHODS
The review of 86 parosteal osteosarcomas of bone revealed this atypical pattern only once. A consultation case was received in the same time, and added to ours. Patients were 28 years old and 56 years old females. Imaging studies included two radiographs, two CTscans, one MRI examination and one bone scan and the results were compared to histology.
RESULTS
On imaging, both lesions presented as ossified lobulated masses attached with a broad base to the underlying cortex. No radiolucent cleft separated the masses and the host bone and cortex continuity between the mass and the femur was seen, with medullary communication. The marrow of the mass had a different density and intensity compared to normal marrow. So, there were features of an osteochondroma (cortex and medullary continuity) and of a parosteal osteosarcoma (ossified marrow). Pathological assessment on the final specimen confirmed the presence of low-grade parosteal osteosarcomas, after an erroneous diagnosis of osteochondroma on the initial biopsy.
CONCLUSIONS
Parosteal osteosarcoma can be rarely confused with osteochondroma. A radiologic-pathologic correlation is essential. Cortex continuity is the most misleading imaging feature that may occur in parosteal osteosarcomas. A knowledge of this misleading pattern will help diagnose the lesion from the beginning.
PubMed: 22613734
DOI: 10.1186/2045-3329-1-2 -
European Radiology 2001The aim of this study was to document the imaging features of recurrent parosteal osteosarcoma. The clinical and imaging records of 33 patients with a parosteal... (Comparative Study)
Comparative Study
The aim of this study was to document the imaging features of recurrent parosteal osteosarcoma. The clinical and imaging records of 33 patients with a parosteal osteosarcoma referred to an orthopaedic oncology service over a 17-year period were retrospectively reviewed. The mode of identification of locally recurrent tumour was noted, together with the management and clinical outcome. Five patients developed a local recurrence of their parosteal osteosarcoma ranging from 6 months to 10 years after initial surgery. In 4 patients the recurrence was first suspected clinically due to the development of a mass. In the fifth patient recurrence was first detected on routine follow-up radiography. In 4 patients the recurrence could be identified on radiography as a mineralized mass. All the recurrences were readily identified on MR imaging, despite artefacts from prostheses. The recurrences were also evident in the 3 cases in which bone scintigraphy was performed. Local recurrence of parosteal osteosarcoma is adequately detected with a combination of clinical examination and conventional radiography. MR imaging is required to stage local recurrence or where radiography has failed to confirm clinically suspected recurrence. The routine use of MR imaging to follow-up patients is of doubtful value because of the frequently long time between initial surgery and relapse.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Bone and Bones; Diagnostic Imaging; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Osteosarcoma, Juxtacortical; Predictive Value of Tests; Retrospective Studies
PubMed: 11288853
DOI: 10.1007/s003300000673 -
Orthopedic Research and Reviews 2023The treatment of low-grade osteosarcomas is surgical resection with wide margins. In instances of dedifferentiation, a therapeutic paradigm similar to that of... (Review)
Review
The treatment of low-grade osteosarcomas is surgical resection with wide margins. In instances of dedifferentiation, a therapeutic paradigm similar to that of conventional high-grade osteosarcoma has not been adequately evaluated in these neoplasms. The main objective of this review was to define whether the addition of chemotherapy to surgical treatment has an impact on the survival of patients with dedifferentiated low-grade osteosarcomas. Secondary objectives were to observe the degree of histological response to neoadjuvant chemotherapy and to describe the percentage of de novo dedifferentiation. A systematic search of articles including dedifferentiated low-grade osteosarcomas, published between 1980 and 2022 was carried out in the PubMed, Cochrane and Scielo databases. A qualitative synthesis of the results was performed. Twenty-three articles comprising 117 patients were included. The survival of patients treated with surgery alone and surgery with chemotherapy was not statistically significant between the two groups. A good histological response was seen in 20% of specimens treated with neoadjuvant chemotherapy. De novo dedifferentiation was seen in approximately a fifth of low-grade osteosarcomas. The evidence available suggests that the addition of chemotherapy does not have an impact on the survival of patients with low-grade dedifferentiated osteosarcomas.
PubMed: 37143718
DOI: 10.2147/ORR.S404146 -
Journal of Oral and Maxillofacial... 2014Parosteal osteosarcomas are rare, low-grade juxtacortical variant of osteosarcoma, especially in the jaws, representing 1.6% of all bony malignant tumours and upto 5% of...
Parosteal osteosarcomas are rare, low-grade juxtacortical variant of osteosarcoma, especially in the jaws, representing 1.6% of all bony malignant tumours and upto 5% of all osteosarcomas. Only 12 cases of intraoral parosteal osteosarcomas have been reported in the English literature. In the jaws males are more commonly affected with peak occurrence at 39 years and nearly equal site predilection for maxilla and mandible. Radiographically, parosteal osteosarcomas are radiodense, lobulated masses with a broad stalk to the cortex of the bone with no periosteal reaction and medullary invasion. Microscopically, shows well-differentiated tumor with minimum atypia and rare mitotic figures separating trabeculae of woven bone. Unlike classical and periosteal osteosarcoma, it is considered to have a good prognosis. A case report of this rare entity in 22-year-old female patient with bony hard, painless swelling of 9 months duration in maxillary premolar-molar region is presented. The need for differential diagnostic approach is emphasized from other seemingly benign clinical entities.
PubMed: 25949002
DOI: 10.4103/0973-029X.151340 -
The Journal of Hand Surgery Dec 2017We present a case of a parosteal osteosarcoma mimicking an osteochondroma with atypical clinical features, radiographic findings, and histological examination. This...
We present a case of a parosteal osteosarcoma mimicking an osteochondroma with atypical clinical features, radiographic findings, and histological examination. This report serves to exemplify the importance of recognizing the similarities between these 2 entities and other peculiar features that will help to differentiate between sessile osteochondromas and parosteal osteosarcomas, to prevent misdiagnosis.
Topics: Bone Neoplasms; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Osteochondroma; Osteosarcoma; Radiography; Radius
PubMed: 28917546
DOI: 10.1016/j.jhsa.2017.07.010 -
Acta Orthopaedica Scandinavica Jun 1991In a study of the working group for bone tumors of the German Orthopedic Society, 33 patients with a histologically confirmed parosteal osteosarcoma at reexamination... (Clinical Trial)
Clinical Trial Comparative Study
In a study of the working group for bone tumors of the German Orthopedic Society, 33 patients with a histologically confirmed parosteal osteosarcoma at reexamination underwent clinical and radiographic follow-up. Local recurrence occurred in all the cases after intralesional surgery and in 4 of 8 cases after marginal excision. The grade of differentiation was decisive for the prognosis. Despite intralesional surgery, the prognosis for Grade 1 tumors was good. Metastases developed in 1 of 23 patients with a Grade 1 tumor and in 4 of 9 patients with a Grade 2 tumor. The single patient with a Grade 3 tumor was treated with adjuvant chemotherapy and was free of disease after 5 years.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Female; Femoral Neoplasms; Follow-Up Studies; Humans; Humerus; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Osteosarcoma; Prognosis; Radius; Retrospective Studies; Tibia; Time Factors
PubMed: 2042459
DOI: 10.3109/17453679108993592 -
Skeletal Radiology Apr 1998Intracortical osteosarcomas originate in the bone cortex and represent the rarest type of osteosarcoma. We describe the clinical, radiological and histological features... (Review)
Review
Intracortical osteosarcomas originate in the bone cortex and represent the rarest type of osteosarcoma. We describe the clinical, radiological and histological features of an intracortical osteosarcoma occurring in the femur of a young man and discuss the pertinent features of this tumour compared to those previously reported.
Topics: Adult; Biopsy; Diagnosis, Differential; Femoral Neoplasms; Femur; Humans; Magnetic Resonance Imaging; Male; Osteosarcoma, Juxtacortical; Tomography, X-Ray Computed
PubMed: 9592909
DOI: 10.1007/s002560050372 -
The Journal of Bone and Joint Surgery.... Aug 2000Parosteal osteosarcoma is a low-grade malignant bone tumor that arises from the surface of the metaphysis of long bones. Parosteal osteosarcoma is usually well... (Clinical Trial)
Clinical Trial
BACKGROUND
Parosteal osteosarcoma is a low-grade malignant bone tumor that arises from the surface of the metaphysis of long bones. Parosteal osteosarcoma is usually well differentiated and displays a low propensity to metastasize. Wide resection of a parosteal osteosarcoma has been shown to provide a relatively risk-free method of preventing local recurrence. We propose a new method of resection of parosteal osteosarcomas located in the popliteal paraosseous space of the distal part of the femur. This method involves resection of the mass through separate medial and lateral incisions, which allows for wide margins yet limits the amount of dissection of the soft tissues and the neurovascular bundle.
METHODS
Six patients with parosteal osteosarcoma located on the posterior aspect of the distal part of the femur underwent resection of the lesion and reconstruction with a posterior hemicortical allograft through dual medial and lateral incisions. The patients were evaluated with regard to pain, postoperative function, union of the allograft (osteosynthesis), and the prevalence of local recurrence.
RESULTS
The average time until the last follow-up assessment was 4.3 years. No metastases developed, and there were no local recurrences. All patients were free of disease at the last follow-up evaluation. Postoperatively, the average range of motion of the knee was 0 to 122 degrees. Five of the six patients were free of pain at the time of the latest follow-up. Five of the six patients returned to their preoperative active functional status.
CONCLUSIONS
We recommend resection of a parosteal osteosarcoma located on the posterior surface of the femur through separate medial and lateral incisions. This approach provides minimal dissection of the neurovascular bundle but ample exposure for reconstruction with a hemicortical allograft.
Topics: Adult; Female; Femoral Neoplasms; Humans; Male; Middle Aged; Orthopedic Procedures; Osteosarcoma, Juxtacortical
PubMed: 10954096
DOI: 10.2106/00004623-200008000-00003