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Oncology Letters Nov 2015The present report describes a case of a 44-year-old female patient who presented with a palpable mass of the left thigh. A diagnosis of parosteal osteosarcoma (POS) at...
The present report describes a case of a 44-year-old female patient who presented with a palpable mass of the left thigh. A diagnosis of parosteal osteosarcoma (POS) at the femoral diaphysis was made following a diagnostic workup. Previous reports of long bone diaphyseal POS are rare. A long diaphyseal segment of the femur containing the tumor was resected along with a healthy margin of soft tissues, and the damaged bone was reconstructed with a custom-made intercalary endoprosthesis. Subsequent pathological examination of the surgical sample confirmed the diagnosis of POS. No local recurrence or distant metastasis was observed, and the patient had a positive Musculoskeletal Tumor Society score of 28/30 (93.3%) at the 28-month post-surgery follow-up. The present study describes the clinical, radiological, and pathological features of this rare type of osteosarcoma.
PubMed: 26722326
DOI: 10.3892/ol.2015.3627 -
National Journal of Maxillofacial... 2015Parosteal osteosarcoma (OS) of the jaw is a rare type of OS with peculiar clinical radiographic and microscopic features. The aim of this article was to report and...
Parosteal osteosarcoma (OS) of the jaw is a rare type of OS with peculiar clinical radiographic and microscopic features. The aim of this article was to report and discuss a case of high-grade parosteal OS in the mandible of a 35-year-old woman. The patient reported sensing mild pain and swelling in the retro molar area on the left side of the mouth for a period of 4 years, despite continuous dental treatment. The radiographic evaluation showed a mixed radiopaque/radiolucent lesion in the body of the left side of the mandible. Destruction of the mandibular cortex in that area was also observed. After the initial histological study, the patient underwent partial hemi-mandibulectomy. Microscopic findings showed a tumor exhibiting spindle cells with nuclear hyperchromasia, moderate pleomorphism, and irregular osteoid formation, with chondroid differentiation noted with tumor-free margins. The immunohistochemical analysis showed the expression of negativity to p53, human epidermal growth factor receptor 2/neu, and positivity to S-100. The diagnosis was high-grade parosteal OS of the jaw. The 4 years clinical and imaging postoperative follow-up showed no evidence of recurrence. The literature on this unusual pathologic entity reviewed and diagnostic challenges described.
PubMed: 26668470
DOI: 10.4103/0975-5950.168232 -
The Bone & Joint Journal Dec 2015The aim of this study was to evaluate the prognostic and therapeutic factors which influence the oncological outcome of parosteal osteosarcoma. A total of 80 patients...
The aim of this study was to evaluate the prognostic and therapeutic factors which influence the oncological outcome of parosteal osteosarcoma. A total of 80 patients with a primary parosteal osteosarcoma were included in this retrospective study. There were 51 females and 29 males with a mean age of 29.9 years (11 to 78). The mean follow-up was 11.2 years (1 to 40). Overall survival was 91.8% at five years and 87.8% at ten years. Local recurrence occurred in 14 (17.5%) patients and was associated with intralesional surgery and a large volume of tumour. On histological examination, 80% of the local recurrences were dedifferentiated high-grade tumours. A total of 12 (14.8%) patients developed pulmonary metastases, of whom half had either a dedifferentiated tumour or a local recurrence. Female gender and young age were good prognostic factors. Local recurrence was a poor prognostic factor for survival. Medullary involvement or the use of chemotherapy had no impact on survival. The main goal in treating a parosteal osteosarcoma must be to achieve a wide surgical margin, as inadequate margins are associated with local recurrence. Local recurrence has a significant negative effect on survival, as 80% of the local recurrences are high-grade dedifferentiated tumours, and half of these patients develop metastases. The role of chemotherapy in the treatment of parosteal osteosarcoma is not as obvious as it is in the treatment of conventional osteosarcoma. The mainstay of treatment is wide local excision.
Topics: Adolescent; Adult; Aged; Biopsy, Needle; Bone Neoplasms; Child; Combined Modality Therapy; Female; Follow-Up Studies; Forecasting; Humans; Male; Middle Aged; Osteosarcoma, Juxtacortical; Periosteum; Prognosis; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 26637687
DOI: 10.1302/0301-620X.97B12.35749 -
Medicina 2015The objective of the study was to analyze a group of patients with low grade parosteal osteosarcoma treated with limb salvage surgery and reconstructed with bone...
The objective of the study was to analyze a group of patients with low grade parosteal osteosarcoma treated with limb salvage surgery and reconstructed with bone allograft. A retrospective review from our oncologic data base between 1980 and 2010 was done and all patients with diagnosis of low grade parosteal osteosarcoma, treated with limb salvage surgery and reconstructed with allograft were included. Twenty-two patients were included for the analysis. The mean age was 32±11 years (10-59) y the mean follow-up 93±69 months (8-237). Ten year overall survival of the series was 91% (95% CI: 79-100). Four patients developed local recurrence, 2 of them histological classified after the resection dedifferentiated parosteal osteosarcoma. Two patients developed distant recurrence, being the lung the only site of metastasis. Ten year limb salvage reconstruction survival was 65% (95% CI: 44-86). Long term survival rate in low grade parosteal osteosarcoma is over 90%. Surgical resection wide margin should be the elective treatment and biological limb salvage reconstruction is a good alternative.
Topics: Adolescent; Adult; Bone Transplantation; Child; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Limb Salvage; Lung Neoplasms; Male; Middle Aged; Neoplasm Grading; Osteosarcoma; Rare Diseases; Retrospective Studies; Survivors; Treatment Outcome; Young Adult
PubMed: 26502465
DOI: No ID Found -
World Journal of Orthopedics Aug 2015A case of florid reactive periostitis ossificans (RPO) arising in a long bone is presented. This is a rare bone proliferation with a pronounced periosteal reaction. Less...
A case of florid reactive periostitis ossificans (RPO) arising in a long bone is presented. This is a rare bone proliferation with a pronounced periosteal reaction. Less than 100 cases have been described in the literature with far fewer outside the bones of the hand, feet, fingers, and toes. Although the etiology is unknown, a relationship to preceding trauma is suggested. The imaging and histologic features show an overlap with other bone lesions including bizarre parosteal osteochondromatous proliferation, subungual exostosis, and malignant surface tumors of bone and cartilage which include, periosteal and parosteal osteosarcoma. It is important to recognize the clinical presentation and diagnostic features of RPO as a benign entity so that it is not mistaken for a more aggressive neoplasm. We present a case of a right distal humeral lesion that on histopathological review revealed florid RPO. This diagnosis was not suspected on imaging studies, but was made on open biopsy of the mass. The patient remains disease free, years postoperatively. In addition to presenting this unique case report, we review the pertinent literature, and offer a differential diagnosis and treatment strategy for its management.
PubMed: 26301184
DOI: 10.5312/wjo.v6.i7.559 -
Modern Pathology : An Official Journal... Oct 2015Parosteal osteosarcoma, low-grade central osteosarcoma, and fibrous dysplasia share similar histological features that may pose a diagnostic challenge. The detection of...
Parosteal osteosarcoma, low-grade central osteosarcoma, and fibrous dysplasia share similar histological features that may pose a diagnostic challenge. The detection of GNAS mutations in primary bone tumors has been useful in clinical practice for diagnosing fibrous dysplasia. However, the recent report of GNAS mutations being detected in a significant proportion of parosteal osteosarcoma challenges the specificity of this mutation. As the number of cases reported in this study was small we set out to determine if these results could be reproduced. We studied 97 formalin-fixed paraffin-embedded low-grade osteosarcomas from 90 patients including 62 parosteal osteosarcomas, of which MDM2 amplification was detected in 79%, 11 periosteal osteosarcomas and 24 low-grade central osteosarcoma samples. The mutational status of GNAS was analyzed in codons p.R201, p.Q227, and other less common GNAS alterations by bidirectional Sanger sequencing and/or next generation sequencing using the Life Technologies Ion Torrent platform. GNAS mutations were not detected in any of the low-grade osteosarcomas from which informative DNA was extracted. Our findings therefore support prior observations that GNAS mutations are highly specific for fibrous dysplasia and occur rarely, if ever, in parosteal and other low-grade osteosarcomas.
Topics: Adult; Bone Neoplasms; Chromogranins; DNA Mutational Analysis; Female; GTP-Binding Protein alpha Subunits, Gs; Gene Amplification; High-Throughput Nucleotide Sequencing; Humans; In Situ Hybridization, Fluorescence; Male; Multiplex Polymerase Chain Reaction; Mutation; Osteosarcoma; Proto-Oncogene Proteins c-mdm2
PubMed: 26248895
DOI: 10.1038/modpathol.2015.91 -
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 -
Acta Ortopedica Mexicana 2014Parosteal osteosarcoma originates on the surface of long bones and spares the medullary canal. Its peak incidence occurs in the third decade of life and it is more...
Parosteal osteosarcoma originates on the surface of long bones and spares the medullary canal. Its peak incidence occurs in the third decade of life and it is more frequent in females than males. The juxtacortical variety of parosteal osteosarcoma is one of the most common ones, accounting for 1-6% of all osteosarcomas. The classical radiographic appearance of osteosarcoma includes high ossification density and a lobed mass, usually in the posterior aspect of the distal femur, sparing the medullary canal. We report herein the case of a 31 year-old male patient with a clinical picture that included left knee pain and who was seen as outpatient. He was started on treatment for enbloc resection of the tumor and implantation of the OSS (Orthopedic Salvage System) prosthesis. Treatment consisted of broad resection of the proximal tibia, of approximately 14 cm, as well as the implantation of a nonconventional modular tibial prosthesis. Both the radiographic and the clinical results were good and appropriate at the three week follow up.
Topics: Adult; Bone Neoplasms; Humans; Male; Osteosarcoma; Prostheses and Implants; Prosthesis Design; Tibia
PubMed: 26021095
DOI: No ID Found -
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 -
Case Reports in Orthopedics 2015Reconstruction after wide resection of a malignant bone tumor can be obtained using several techniques such as the use of prostheses, allograft, autograft, or combined...
Reconstruction after wide resection of a malignant bone tumor can be obtained using several techniques such as the use of prostheses, allograft, autograft, or combined procedure. We describe a 12-year-old girl with parosteal osteosarcoma of the distal right humerus treated by en bloc resection, intraoperative extracorporeal irradiation, and implantation. We inserted a nonvascularised fibular autograft through the middle of irradiated graft to obtain a greater stability. We have not recorded any complication associated with this technique such as nonunion, pathological fracture, infection, and bone necrosis and we obtained an excellent functional result. 10 years after surgery, the patient had no recurrence. Extracorporeal irradiation and reimplantation is a valid and inexpensive technique for the treatment of bone tumors when there is reasonable residual bone stock. With this procedure we have a precise fit being the patient's own bone. In this way we avoid all the problems related to the adaptation of the shape and size.
PubMed: 25648359
DOI: 10.1155/2015/404979