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Orthopaedics & Traumatology, Surgery &... Jun 2022Proximity of tumor to the neurovascular bundle (NVB) makes achieving a wide margin difficult. In low-grade parosteal osteosarcoma (POS), it is not clear whether...
BACKGROUND
Proximity of tumor to the neurovascular bundle (NVB) makes achieving a wide margin difficult. In low-grade parosteal osteosarcoma (POS), it is not clear whether adherence of tumor to NVB increases the rate of local recurrence (LR). In this study, we evaluated whether tumor adherence to the NVB increases the risk of LR in low-grade POS of the distal femur?
HYPOTHESIS
We hypothesized that if the thin neurovascular barrier (the adventitia of the vessels and the epineurium of the nerve) prevents tumor penetration, the rate of LR should be comparable between the lesions with and without a continuous layer of healthy fatty tissue between the tumor and NVB.
MATERIALS AND METHODS
In a retrospective survey, 30 patients with low-grade POS of the posterior aspect of the distal femur were evaluated for the proximity of mass to NVB. Based on the proximal to distal T1 axial MRI sections, the tumors were divided into two groups including the tumors with an uninterrupted (group A) and interrupted (group B) rim of fatty tissue between the mass and NVB. The rate of LR was compared between the two study groups. The concordance of MRI in detecting NVB adherence was checked with pathology specimen.
RESULTS
Using MRI, we identified 16 cases in group A and 14 cases in group B. The MRI status of fatty rim was concordant with pathology specimen in 96.4% of cases. The mean follow-up period of the two groups was not statistically different (117±27.6 vs. 105.8±29.4 months, respectively, p=0.29). The other baseline characteristics of the two groups were statistically comparable, as well. The rate of LR was 12.5% (2 out of 16 patients) in group A and 14.3% (2 out of 14 patients) in group B (95% CI: 0.142-9.586, p=0.87). The 10-year recurrence-free survival was 87.5% for group A and 85.7% for group B (p=0.9).
DISCUSSION
The absence of a continuous rim of fatty tissue between the tumor and NVB in MRI does not increase the risk of LR in low-grade POS of the distal femur.
LEVEL OF EVIDENCE
IV.
Topics: Bone Neoplasms; Femur; Humans; Osteosarcoma; Osteosarcoma, Juxtacortical; Recurrence; Retrospective Studies
PubMed: 35093566
DOI: 10.1016/j.otsr.2022.103220 -
Cancer May 1976A clinicopathologic study of 79 patients with parosteal osteogenic sarcoma revealed that more females than males were affected and that most of the patients were in the...
A clinicopathologic study of 79 patients with parosteal osteogenic sarcoma revealed that more females than males were affected and that most of the patients were in the second to the fourth decades of life. Sixty-eight percent of the patients had involvement of the posterior aspect of the lower femoral shaft. The roentgenogram characteristically showed a large, dense lobulated mass attached by a broad base to the underlying bone but with no involvement of bone itself. Microscopically, the tumor presented as well-formed bands of osteoid within a hypocellular spindle cell stroma. Seven of the lesions had foci of high-grade osteogenic sarcoma within an otherwise typical parosteal osteogenic sarcoma. Six of the 79 lesions showed involvement of the medullary cavity at surgery. Thirty-one patients had excision as their initial treatment; four of the 31 required nv further therapy. Ten patients had resection initially; three of the ten had recurrence. Only four of 27 patients who underwent amputation initially developed pulmonary metastasis. The presence of histologically "active" tumor and medullary involvement seemed to affect the prognosis adversely. Our data indicate that complete radical removal of the tumor is the treatment of choice, with resection when feasible and amputation when necessary.
Topics: Amputation, Surgical; Bone Marrow; Bone Neoplasms; Humans; Neoplasm Metastasis; Neoplasms, Multiple Primary; Osteosarcoma; Periosteum; Radiography
PubMed: 1063060
DOI: 10.1002/1097-0142(197605)37:5<2466::aid-cncr2820370540>3.0.co;2-g -
Skeletal Radiology Jan 2010
Topics: Bone Neoplasms; Humans; Osteosarcoma; Radiography; Telangiectasis
PubMed: 19826810
DOI: 10.1007/s00256-009-0814-7 -
Journal of Molecular Histology Feb 2012The aim of this study was to investigate the expression patterns of IGF2 and IMP3 in osteosarcoma as well as its relationship with angiogenesis in the tumor. IGF2 and...
The aim of this study was to investigate the expression patterns of IGF2 and IMP3 in osteosarcoma as well as its relationship with angiogenesis in the tumor. IGF2 and IMP3 expression was detected by immunohistochemical staining in the serial sections of the osteosarcoma. The impacts of IGF2 and IMP3 expression patterns on tumor angiogenesis were evaluated by statistics. The IGF2 and IMP3 staining had different expression patterns in different osteosarcoma. Twelve out of the sixty-four cases of conventional osteosarcoma showed nuclear staining patterns, and twenty-nine showed cytoplasmic staining of IGF2 and IMP3 simultaneously. On the other hand, fourteen cases showed nuclear IGF2 staining but cytoplasmic IMP3 expression, and nine cases showed nuclear IMP3 staining and cytoplasmic IGF2 expression. Twenty-eight out of forty-seven cases of parosteal osteosarcoma showed nuclear IGF2 and IMP3 expression, nine showed cytoplasmic IGF2 and IMP3 expression simultaneously. Seven out of forty-seven cases of parosteal osteosarcoma expressed IGF2 with nuclear staining but expressed IMP3 with cytoplasmic staining. Meanwhile, three cases expressed IGF2 with cytoplasmic staining but expressed IMP3 with nuclear staining. Similar to the parosteal osteosarcoma, the periosteal osteosarcoma expressed IGF2 and IMP3 mainly with nuclear staining simultaneously, forty out of fifty-five cases of periosteal osteosarcoma did that. Five out of fifty-five cases expressed IGF2 and IMP3 with cytoplasmic staining at the same time. Four cases showed nuclear IGF2 staining and cytoplasmic IMP3 staining. In the parosteal and periosteal osteosarcoma, there was no significant difference in IGF and IMP3 expression patterns (P = 0.216). However, compared with conventional osteosarcoma, the parosteal and periosteal osteosarcoma showed significant difference in IMP3 and IGF2 expression (P = 0.016, P = 0.023). IGF2 and IMP3 expression patterns were positive correlation in the different osteosarcoma (r = 0.1021, P = 0.032). The Microvessel density (MVD) in osteosarcoma with IGF2 and IMP3 cytoplasmic staining was more than that with nuclear expression of IGF2 and IMP3, and the difference was significant (P = 0.024). Moreover, the conventional osteosarcoma with cytoplasmic IGF and IMP3 showed more MVD than parosteal and periosteal osteosarcoma with cytoplasmic IGF and IMP3, and the difference was significant (P = 0.035). IGF2 and IMP3 had different expression patterns, which might be associated with angiogenesis. However, cytoplasmic and nuclear expression of IGF2 and IMP3 might play different roles in the angiogenesis of osteosarcoma.
Topics: Bone Neoplasms; Humans; Immunohistochemistry; Insulin-Like Growth Factor II; Intracellular Space; Neovascularization, Pathologic; Osteosarcoma; RNA-Binding Proteins
PubMed: 22042095
DOI: 10.1007/s10735-011-9370-2 -
The American Journal of Roentgenology,... Mar 1971
Topics: Adolescent; Adult; Amputation, Surgical; Bone Neoplasms; Female; Femoral Neoplasms; Humans; Humerus; Male; Middle Aged; Neoplasm Metastasis; Osteosarcoma; Radiography; Tibia; Ulna
PubMed: 5279034
DOI: 10.2214/ajr.111.3.579 -
Archives of Pathology & Laboratory... Mar 1999Parosteal osteosarcoma with dedifferentiation provides a useful model to study tumor progression from an indolent locally aggressive neoplasm to highly lethal...
BACKGROUND
Parosteal osteosarcoma with dedifferentiation provides a useful model to study tumor progression from an indolent locally aggressive neoplasm to highly lethal metastasizing malignancy. Up-regulation of the proteolytic enzymes participating in stromal degradation is known to promote invasive growth and metastasis of several human and experimental tumors.
METHODS
The expression patterns of urokinasase plasminogen activator (u-PA), its cell-surface receptor (u-PAR), and cathepsin B were analyzed by immunohistochemical techniques in 11 cases of parosteal osteosarcoma and in 4 cases of dedifferentiated parosteal osteosarcoma.
RESULTS
Both enzymes and the receptor were coexpressed in most tumor cells of parosteal and dedifferentiated parosteal osteosarcoma. Their expression was strikingly enhanced in the dedifferentiated high-grade component of the tumors. Tumor cells involved in bone production (ie, those adjacent to tumor produced bone trabeculae) exhibited equally strong expression of u-PA, u-PAR, and cathepsin B, regardless of their histologic grade. Expression of u-PA, u-PAR, and cathepsin B was undetectable in the "normalized" cells embedded in the well-developed tumor bone trabeculae.
CONCLUSION
These data indicate that u-PA and its interacting molecules, such as u-PAR and cathepsin B, may have some contributory effects on the metastatic potential of tumor cells in dedifferentiated parosteal osteosarcoma.
Topics: Bone Neoplasms; Cathepsin B; Child; Child, Preschool; Female; Humans; Immunoenzyme Techniques; Immunohistochemistry; Male; Osteosarcoma, Juxtacortical; Plasminogen Activators; Receptors, Cell Surface; Receptors, Urokinase Plasminogen Activator
PubMed: 10086509
DOI: 10.5858/1999-123-0213-PEIDPO -
Skeletal Radiology Jan 2021Surface lesions of bone are uncommon. Although their imaging features generally mirror those of their intramedullary counterparts, surface lesions may demonstrate... (Review)
Review
Surface lesions of bone are uncommon. Although their imaging features generally mirror those of their intramedullary counterparts, surface lesions may demonstrate distinct characteristics which along with their unusual location present a diagnostic challenge. Surface sarcomas are usually of a lower grade compared with intramedullary variants, leading to differences in management. Osteosarcoma arising from the cortical surface of the bone is termed juxtacortical or surface osteosarcoma and includes three distinct entities: parosteal, periosteal, and high-grade surface osteosarcoma. We also review the features intracortical osteosarcoma, which some authors include under the umbrella term surface osteosarcoma. These lesions exhibit biologic features distinct from those of conventional intramedullary osteosarcoma, which underlines the importance of accurate imaging diagnosis. Periosteal chondrosarcoma and periosteal Ewing sarcoma also have distinctive imaging appearances. The purpose of this article is to review surface sarcomas of bone with regard to their clinical and radiological features and to discuss the differential diagnosis for each condition.
Topics: Bone Neoplasms; Bone and Bones; Chondrosarcoma; Humans; Osteosarcoma; Soft Tissue Neoplasms
PubMed: 32681279
DOI: 10.1007/s00256-020-03546-1 -
International Journal of Clinical... Apr 2006This retrospective review evaluated the clinical features and surgical outcomes of parosteal osteosarcoma (POS).
BACKGROUND
This retrospective review evaluated the clinical features and surgical outcomes of parosteal osteosarcoma (POS).
METHODS
Nine patients were surgically treated and followed up. Their mean age was 30.8 years. Clinical information and oncologic outcomes of each case were analyzed.
RESULTS
Sites of involvement were all in the femur, and all tumors arose from the metaphyseal area of the distal femur. Biopsies for definite diagnoses were performed in just two of the nine cases. Wide resection was applied for all tumors. Surgical evaluations were a 1-cm-wide procedure in six cases and a 2-cm-wide procedure (or more) in three cases. All patients were found to be continuously disease free during the follow-up period of 115.1 months.
CONCLUSION
POS showed characteristic findings on radiographic images. Therefore, wide resection without biopsy could be performed in 77.8% (7/9) of the cases. This procedure may contribute to attaining better limb function, because of preventing contamination of healthy surrounding tissue and minimizing the extent of resection. The safety margin was evaluated as a 1-cm-wide procedure. For the choice of reconstruction, indication of autobone grafting (3/9) or total knee replacement (TKR) (6/9) depended on tumor size, location, and shape. With no adjuvant treatments, all cases have shown good clinical courses during the entire follow-up period of about 10 years.
Topics: Adolescent; Adult; Bone Neoplasms; Female; Femur; Follow-Up Studies; Humans; Male; Middle Aged; Orthopedic Procedures; Osteosarcoma; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 16622746
DOI: 10.1007/s10147-005-0545-2 -
Acta Orthopaedica Scandinavica Jun 1994Differentiation of periosteal osteosarcoma and parosteal (periosteal) chondrosarcoma by conventional histology may be difficult. One case each of clinically and...
Differentiation of periosteal osteosarcoma and parosteal (periosteal) chondrosarcoma by conventional histology may be difficult. One case each of clinically and histologically proven periosteal osteosarcoma and parosteal chondrosarcoma were evaluated by a double-immunohistochemical staining method using proliferating cell nuclear antigen (PCNA) and S-100 protein (S-100). Conventional histology showed proliferation of both osteoblastic and chondroblastic cells in the periosteal osteosarcoma, while there was a growth of only chondroblastic tumor cells in the parosteal chondrosarcoma. Immunohistochemical studies indicated that the nuclei of chondroblastic cells recognized by S-100 were PCNA-negative, while osteoblastic stromal cells were PCNA-positive in the periosteal osteosarcoma. In contrast, chondroblastic cells in the parosteal chondrosarcoma were both S-100- and PCNA-positive. Our findings suggest that periosteal osteosarcoma is characterized by the proliferation of osteoblastic stromal cells, whereas parosteal chondrosarcoma is characterized by the proliferation of chondroblastic cells. This method of double immunohistochemical staining, using PCNA and S-100, may be useful in differentiating these chondroblastic tumors.
Topics: Adolescent; Aged; Antigens, Neoplasm; Bone Neoplasms; Chondrosarcoma; Diagnosis, Differential; Humans; Immunohistochemistry; Male; Nuclear Proteins; Osteosarcoma; Periosteum; Proliferating Cell Nuclear Antigen; S100 Proteins; Staining and Labeling
PubMed: 7518993
DOI: 10.3109/17453679408995471 -
Skeletal Radiology Sep 1999Dedifferentiated parosteal osteosarcomas are characterized histologically by the combination of low-grade fibroblastic osteosarcoma admixed with a high-grade component...
Dedifferentiated parosteal osteosarcomas are characterized histologically by the combination of low-grade fibroblastic osteosarcoma admixed with a high-grade component that typically has the appearance of malignant fibrous histiocytoma or osteosarcoma. Herein we report a case of dedifferentiated parosteal osteosarcoma of the distal femur, in which the high-grade component consisted of rhabdomyosarcoma. To our knowledge, a rhabdomyosarcomatous component has not been described previously in a dedifferentiated parosteal osteosarcoma. The clinical, radiologic, and pathologic features of this rare type of surface osteosarcoma are described.
Topics: Adult; Bone Neoplasms; Female; Femur; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Osteosarcoma; Pregnancy; Pregnancy Complications, Neoplastic; Rhabdomyosarcoma; Tomography, X-Ray Computed
PubMed: 10525797
DOI: 10.1007/s002560050557