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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 -
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 -
Journal of Surgical Oncology Feb 2008Parosteal osteosarcoma is a rare type of osteosarcoma with distinct characteristics. Clinical outcome of 21 patients was analyzed to assess the predictive relevance of...
BACKGROUND
Parosteal osteosarcoma is a rare type of osteosarcoma with distinct characteristics. Clinical outcome of 21 patients was analyzed to assess the predictive relevance of surgical margin, intramedullary tumor extension and histologic grade.
METHODS
There were 5 mens and 16 womens with an average age of 26 years. Average follow-up was 9.1 years (range 2.5-22.1). Most common sites were distal femur (15) and proximal humerus (2). No patient presented with metastasis. Surgical margin was wide in 13 and marginal in 8. Intramedullary extension was seen in 10 patients (48%). Focal high-grade 2 and 3 tumors were seen in 11 (52%) and 3 (14%) patients respectively.
RESULTS
Twenty patients (95%) were alive without disease. Two (10%) had relapse, one with local recurrence and another with local recurrence and lung metastasis. Of eight marginal procedures performed, 2 turned out to have histologically tumor-positive margins, both of whom later developed relapses. All patients with histologically negative margins remained disease-free. Presence of intramedullary extension and focal high-grade tumor was not significantly associated with relapse.
CONCLUSIONS
A marginal but histologically negative margin of excision appears adequate for parosteal osteosarcoma. However, long-term follow-up is warranted for monitoring of rare incidences of local recurrences or distant metastases.
Topics: Adolescent; Adult; Bone Marrow; Bone Neoplasms; Disease-Free Survival; Female; Femoral Neoplasms; Fibula; Follow-Up Studies; Humans; Humerus; Ilium; Lung Neoplasms; Male; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm, Residual; Osteosarcoma, Juxtacortical; Retrospective Studies; Tibia; Treatment Outcome
PubMed: 18050289
DOI: 10.1002/jso.20902 -
Cancer Jun 2005Dedifferentiated parosteal osteosarcoma (DPOS) is a variant of osteosarcoma in which a high-grade sarcoma coexists with a conventional parosteal osteosarcoma (c-POS),...
BACKGROUND
Dedifferentiated parosteal osteosarcoma (DPOS) is a variant of osteosarcoma in which a high-grade sarcoma coexists with a conventional parosteal osteosarcoma (c-POS), either at presentation (synchronous type) or at the time of recurrence (metachronous type). Only approximately 60 patients have been reported in the literature. The objective of this study was to analyze the clinicopathologic and radiographic features of a relatively large number of patients with DPOS in an attempt to define further the histologic and biologic behavior of this rare entity.
METHODS
In a series of 120 patients with parosteal osteosarcoma who were seen at the Rizzoli Institute from 1958 to 2000, the authors identified 29 patients who were diagnosed with DPOS. The authors reviewed the clinical and radiologic features, histologic sections, treatments, and outcomes in this group of patients with DPOS.
RESULTS
Twelve patients were male, and 17 patients were female. The patients ranged in age from 15 years to 65 yrs (average, 36 years; median, 32 years). One tumor involved the scapula, one involved the ilium, and another involved the skull. All 26 of the other tumors were located in the long bones (14 in the femur, 5 in the humerus, 3 in the tibia, 3 in the fibula, and 1 in the ulna). In 18 patients, radiographic areas of lucency were seen within an otherwise sclerotic lesion. Histologically, the dedifferentiated component was high-grade osteoblastic osteosarcoma in 14 patients, fibroblastic osteosarcoma in 10 patients, giant cell-rich osteosarcoma in 3 patients, and chondroblastic osteosarcoma in 2 patients. All tumors were Stage IIB, and invasion of the medullary canal was detected in 19 patients (65%). Twenty-eight patients underwent surgery, and 18 of those patients received chemotherapy (5 patients received neoadjuvant chemotherapy, and 13 patients received adjuvant). Nine patients were dead and 20 patients were alive (average follow-up, 107 months; range, from 3 months to 36 years) at the last follow-up. Of the nine patients who died, one patient received no treatment, five patients underwent surgery (with three patients achieving adequate margins) in combination with chemotherapy, and three patients underwent surgery only (with adequate margins achieved). Of the 20 patients who remained alive, 13 patients underwent surgery (with 10 patients achieving adequate margins) in combination with chemotherapy, whereas 7 patients underwent surgery only (all with adequate margins). Seven of the nine patients who died had widespread metastases. One patient died of causes unrelated to the tumor, and another patient died shortly after undergoing resection of a lesion in the skull.
CONCLUSIONS
Dedifferentiation occurred in approximately 24% of patients with c-POS. The prognosis for patients with DPOS was better than the prognosis for patients with dedifferentiated central and dedifferentiated peripheral chondrosarcoma.
Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Bone Neoplasms; Cell Differentiation; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Osteosarcoma, Juxtacortical; Prognosis; Retrospective Studies; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 15852358
DOI: 10.1002/cncr.21039 -
Journal of the American Veterinary... Apr 1989A mandibular parosteal osteosarcoma was diagnosed in a 7-year-old Collie with prolapse of the third eyelid. Diagnosis was made by histologic evaluation of a mass removed...
A mandibular parosteal osteosarcoma was diagnosed in a 7-year-old Collie with prolapse of the third eyelid. Diagnosis was made by histologic evaluation of a mass removed by surgical excision. The dog was euthanatized because of local recurrence of the tumor, with metastasis to the lungs. Parosteal osteosarcomas are rarely reported in dogs and usually involve long bones in human beings.
Topics: Animals; Dog Diseases; Dogs; Female; Lung Neoplasms; Mandibular Neoplasms; Osteosarcoma; Recurrence
PubMed: 2708113
DOI: No ID Found -
Skeletal Radiology Oct 1998We report a case of a 32-year-old woman who presented with parosteal osteosarcoma of the distal femur with simultaneous dedifferentiation to a high-grade osteoclast-rich... (Review)
Review
We report a case of a 32-year-old woman who presented with parosteal osteosarcoma of the distal femur with simultaneous dedifferentiation to a high-grade osteoclast-rich osteogenic sarcoma. This pattern of dedifferentiation is rare, particularly at the time of presentation. We are aware of three other somewhat comparable cases in the literature; however, none is quite similar to our case.
Topics: Adult; Biopsy; Combined Modality Therapy; Female; Femoral Neoplasms; Femur; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Neoplasms, Second Primary; Osteoclasts; Osteosarcoma; Osteosarcoma, Juxtacortical; Radiography
PubMed: 9840395
DOI: 10.1007/s002560050440 -
The Indian Journal of Surgery Jun 2015The aim of this study was to investigate the expression of DACH1 in osteosarcoma as well as its relationship with cell proliferation and angiogenesis in the tumor. DACH1...
The aim of this study was to investigate the expression of DACH1 in osteosarcoma as well as its relationship with cell proliferation and angiogenesis in the tumor. DACH1 expression was detected by immunohistochemical staining in the serial sections of the osteosarcoma. The microvessel density (MVD) was counted by CD34 immunohistochemical staining, and immunohistochemical staining of PCNA staining showed the cell proliferation. The impacts of DACH1 expression on tumor proliferation and angiogenesis were evaluated by statistics. The DACH1 had different expression patterns in different osteosarcoma. Conventional osteosarcoma showed stronger DACH1 staining (conventional vs. parosteal: P = 0.037; conventional vs. periosteal: P = 0.028) and more PCNA-positive tumor cells than parosteal and periosteal osteosarcoma (conventional vs. parosteal: P = 0.041; conventional vs. periosteal: P = 0.045), the difference was significant. In addition, conventional osteosarcoma showed more cytoplasmic staining of DACH1 than parosteal and periosteal (conventional vs. parosteal: P = 0.023; conventional vs. periosteal: P = 0.030). Parosteal and periosteal osteosarcoma showed no significant difference in DACH1 expression and cell proliferation index. On the other hand, DACH1 different expression patterns showed significantly different impacts on angiogenesis. In spite of the different subtypes of osteosarcoma, the MVD showed a significant difference in cytoplasmic and nuclear expression patterns of DACH1 (nuclear expression vs. cytoplasmic expression: 5.72 ± 1.19 vs. 9.65 ± 1.24, P = 0.042). Moreover, in the conventional osteosarcoma, the MVD also showed a significant difference in DACH1 cytoplasmic and nuclear staining (nuclear expression vs. cytoplasmic expression: 5.58 ± 0.71 vs. 13.65 ± 1.30, P = 0.019). However, the DACH1 expression intensity showed no significant different impacts on MVD of all kinds of osteosarcoma. DACH1 had different expression patterns and intensity. Cytoplasmic and nuclear expression of DACH1 might play different roles in cell proliferation and angiogenesis of osteosarcoma. Cytoplasmic DACH1 might promote cell proliferation and be associated with angiogenesis.
PubMed: 26246702
DOI: 10.1007/s12262-012-0761-8 -
Interactive Cardiovascular and Thoracic... Jul 2012Osteosarcoma is a common primary malignant tumour of bones that produces an osteoid matrix. Parosteal osteosarcoma is an uncommon neoplasm and principally affects the...
Osteosarcoma is a common primary malignant tumour of bones that produces an osteoid matrix. Parosteal osteosarcoma is an uncommon neoplasm and principally affects the long bones, especially in the distal femur, proximal tibia and proximal humerus. Rarely, the tumour may arise in a flat bone, and rib involvement is very infrequent. An unusual case of primary parosteal osteosarcoma of the rib in an asymptomatic 28-year old female is presented here. A chest X-ray film suggested an intrapulmonary homogeneous mass, while a computed tomography scan revealed a broad-based calcified mass attached to the inner cortex of the right fourth anterior rib. The patient underwent a wide excision of the tumour together with adjacent intercostal muscles and chest wall reconstruction. Postoperative histopathological outcome was consistent with primary parosteal osteosarcoma.
Topics: Adult; Asymptomatic Diseases; Bone Neoplasms; Female; Humans; Osteosarcoma; Osteotomy; Ribs; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 22514259
DOI: 10.1093/icvts/ivs081 -
Journal of the Chinese Medical... Oct 2018Most instances of the parosteal osteosarcoma (OGS) are low-grade tumors. However, some parosteal OGSs undergo dedifferentiated transformation. Dedifferentiated parosteal...
BACKGROUND
Most instances of the parosteal osteosarcoma (OGS) are low-grade tumors. However, some parosteal OGSs undergo dedifferentiated transformation. Dedifferentiated parosteal OGS can cause distant metastasis and poor survival, and preoperative chemotherapy may be warranted. This study provides imaging clues for dedifferentiated parosteal OGS before treatment.
METHODS
The study retrospectively enrolled 23 patients with histologically proven parosteal OGS, including 69.6% (n = 16) low-grade and 30.4% (n = 7) dedifferentiated types. Preoperative images including radiography and magnetic resonance imaging were reviewed. The following imaging parameters and clinical outcomes were evaluated: 1) average age; 2) sex; 3) tumor size; 4) presence of string sign; 5) necrosis; 6) hemorrhage; 7) solid soft tissue component; 8) perforating vessels; 9) ossification grade; 10) marginal ossification; 11) periosteal reaction; 12) sunburst reaction; 13) bone marrow edema; 14) bone marrow invasion; 15) perifocal soft tissue edema; 16) adjacent joint involvement; 17) adjacent neurovascular bundle compression; 18) regional lymph node; 19) bone metastasis; 20) preoperative lung metastasis; 21) follow-up lung metastasis; and 22) recurrence.
RESULTS
The average maximal tumor sizes were 7.1 cm and 10.9 cm in low-grade and dedifferentiated types, respectively (p = 0.033). Sunburst periosteal reaction was visualized in two cases of low-grade type (12.5%) and four cases of the dedifferentiated type (57.1%) (p = 0.025) of parosteal OGS. None of our studied cases revealed preoperative lung metastasis. In the follow-up chest computed tomography, lung metastasis was noted in two cases of conventional type (14.2%), and four cases of dedifferentiated type (57.1%) (p = 0.040) of parosteal OGS. In receiver operating characteristic (ROC) curve analysis, the average tumor size and sunburst periosteal reaction showed good specificity (AUC = 0.070 and 0.072, respectively).
CONCLUSION
Compared with low-grade types, dedifferentiated parosteal OGS exhibits a considerably larger tumor size, more sunburst periosteal reaction, and a more frequent development of lung metastasis in the disease course. Tumor size and sunburst periosteal reaction are the most crucial imaging diagnostic factors.
Topics: Adolescent; Adult; Bone Neoplasms; Cell Dedifferentiation; Female; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Osteosarcoma, Juxtacortical; Young Adult
PubMed: 30190236
DOI: 10.1016/j.jcma.2018.01.014 -
Journal of Bone Oncology Dec 2015Surface osteosarcoma are rare variant of osteosarcoma that include parosteal osteosarcoma, periosteal osteosarcoma and high grade surface osteosarcoma. These lesions...
INTRODUCTION
Surface osteosarcoma are rare variant of osteosarcoma that include parosteal osteosarcoma, periosteal osteosarcoma and high grade surface osteosarcoma. These lesions have different clinical presentation and biological behavior compared to conventional osteosarcoma, and hence need to be managed differently.
GOAL
The aim of this study is to analyze the clinico-pathological features and outcome of a series of surface osteosarcoma in an attempt to define the adequate treatment of this rare entity.
PATIENT AND METHOD
It is a retrospective and bicentric study of 18 surface osteosarcoma that were seen at the KASSAB's Institute and SAHLOUL Hospital from 2006 to 2013. The authors reviewed the clinical and radiologic features, histologic sections, treatments, and outcomes in this group of patients.
RESULTS
Seven patients were male (38.9%) and 11 were female (61.1%) with mean age of 25 years (range from 16 to 55 years). Eleven lesions were in the femur and 7 in the tibia. We identified 11 parosteal osteosarcoma (six of them were dedifferentiated), 3 periosteal osteosarcoma and 4 high grade surface osteosarcoma. Six patients had neoadjuvant chemotherapy and all lesions had surgical resection. Margins were wide in 15 cases and intra lesional in 3 cases. Histological response to chemotherapy was poor in all cases. The mean follow up was 34.5 months. Six patients (33.3%) presented local recurrence and 8 patients (44.4%) presented lung metastases. Six patients (33.3%) died from the disease after a mean follow up of 12 months (6-30 months); all of them had high grade lesions.
CONCLUSION
Histological grade of malignancy is the main point to assess in surface osteosarcoma since it determines treatment and prognosis. Low grade lesions should be treated by wide resection, while high grade lesions need more aggressive surgical approach associated to post operative chemotherapy.
PubMed: 26730360
DOI: 10.1016/j.jbo.2015.07.002