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Journal of Surgical Case Reports Jan 2015We report the case of a 45-year-old woman who presented with a lump in the mid-third of the left clavicle, which had recently increased in size to 10 cm in diameter....
We report the case of a 45-year-old woman who presented with a lump in the mid-third of the left clavicle, which had recently increased in size to 10 cm in diameter. Plain X-ray, computed tomography and bone scans suggested that the lump was a parosteal osteosarcoma. Due to the expected 30% functional loss from claviculectomy [Wood in The results of total claviculectomy. Clin Orthop Relat Res 1986; 207: :186-90.], the patient opted for excision of the tumour plus the adjacent clavicle, irradiation and reimplantation of the bone with internal fixation. On 2-year follow-up, there was no evidence of recurrence or complications, with a good range of movement of the joint. On 4-year follow-up, the patient was found to have discomfort, and X-rays showed that the clavicle had fractured, which was managed symptomatically.
PubMed: 25600129
DOI: 10.1093/jscr/rju151 -
The Tohoku Journal of Experimental... Jul 2014Parosteal osteosarcoma (POS) is a low-grade well-differentiated variant of osteosarcoma that affects the metaphyseal surface of a long bone. Although Grade-1 POS...
Parosteal osteosarcoma (POS) is a low-grade well-differentiated variant of osteosarcoma that affects the metaphyseal surface of a long bone. Although Grade-1 POS sometimes involve the medullary canal, such patients are not at a greater risk of local recurrence or metastases. In this report, we describe a rare case of POS in the right distal femur with an intramedullary sclerotic lesion mimicking medullary involvement caused by secondary remodeling of the underlying cortex of the tumor. A 34-year-old woman complained of having a painful hard mass in her right knee for six months. Imaging studies revealed a broad-based sclerotic mass attached to the cortex of the distal and lateral aspect of the femur, along with an intramedullary lesion. Histopathological examination of a biopsy specimen revealed Grade-1 POS. We diagnosed a medullary involvement and we performed a wide resection, including the intramedullary lesion. Histopathological examination of the resected specimen revealed that the intramedullary lesion only exhibited remodeling of the underlying tumor cortex without tumor cell invasion. To the best of our knowledge, this is the first report of such imaging features and pathological findings in a patient with POS. Our experience with the present patient indicates that good local control and overall prognosis of patients with medullary involvement in Grade-1 POS may be due to the remodeling of the underlying cortex mimicking "medullary involvement." This feature will add to the range of diagnostic difficulty experienced during the preoperative staging of POS.
Topics: Adult; Bone Plates; Bone Remodeling; Bone Transplantation; Female; Femur; Histological Techniques; Humans; Magnetic Resonance Imaging; Osteosarcoma; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 24965686
DOI: 10.1620/tjem.233.165 -
Indian Journal of Orthopaedics May 2014Surface osteosarcomas are a rare form of osteosarcomas accounting for around 3-6% of all osteosarcomas. Three major groups of surface osteosarcomas are parosteal,...
Surface osteosarcomas are a rare form of osteosarcomas accounting for around 3-6% of all osteosarcomas. Three major groups of surface osteosarcomas are parosteal, periosteal and the high grade surface osteosarcomas. Of these, the parosteal osteosarcoma is the most common. Parosteal and periosteal osteosarcomas are distinct clinical entities and it is important to identify the clinicoradiological differences between the two types. Surface osteosarcomas occur at a later age as compared to conventional osteosarcomas. The classical site is the lower end of the femur followed by the upper end of the tibia and upper end of humerus, in that order. The periosteal variant affects the tibia more commonly than the parosteal variety. Neo-adjuvant chemotherapy is the standard of care for high grade surface osteosarcomas. Parosteal osteosarcomas, being low grade lesions, can be treated by upfront wide excision without adjuvant systemic therapy. Controversy prevails over the need for chemotherapy in periosteal osteosarcomas, which are intermediate grade lesions.
PubMed: 24932030
DOI: 10.4103/0019-5413.132503 -
Korean Journal of Radiology 2014Periosteal osteosarcoma is an extremely rare chondroblastic osteosarcoma in the flat bone. There were authors reporting of two cases of periosteal osteosarcoma in the...
Periosteal osteosarcoma is an extremely rare chondroblastic osteosarcoma in the flat bone. There were authors reporting of two cases of periosteal osteosarcoma in the highly unusual sites. One of them arose from the rib, in a 17-year-old male, which appeared as a hypodense juxtacortical mass with periosteal reaction on CT. The other one arose from the scapula, in a 17-year-old female, which showed the intermediate signal intensity (SI) on T1-weighted image (WI), heterogeneous high SI on T2WI, and rim-enhancement on contrast-enhanced T1WI with cortical destruction on MRI.
Topics: Adolescent; Bone Neoplasms; Contrast Media; Female; Humans; Male; Osteosarcoma; Radiography; Ribs; Scapula
PubMed: 24843242
DOI: 10.3348/kjr.2014.15.3.370 -
Archives of Pathology & Laboratory... May 2014Parosteal osteosarcoma is a rare malignant bone tumor arising from the bone cortical surface. It most commonly occurs in young women over the metaphyseal region,... (Review)
Review
Parosteal osteosarcoma is a rare malignant bone tumor arising from the bone cortical surface. It most commonly occurs in young women over the metaphyseal region, especially the long bones near the knee joint. Patients usually report a slow-growing mass for years. The tumor is characterized by its bland microscopic morphology, prone to be misdiagnosed as other benign tumors. In the absence of dedifferentiation, the prognosis is generally better than that of conventional osteosarcoma. Recent studies demonstrated distinctive cytogenetic abnormality resulting in amplification of the CDK4 and MDM2 genes, which may serve as markers for molecular diagnosis. In this article, we review the clinical, radiologic, and pathologic features of parosteal osteosarcoma and identify some diagnostic pitfalls, discuss the prognostic variables, and update recent molecular advances and their application in the diagnosis.
Topics: Biomarkers, Tumor; Bone Neoplasms; Cyclin-Dependent Kinase 4; Diagnosis, Differential; Humans; Knee Joint; Osteosarcoma; Prognosis; Proto-Oncogene Proteins c-mdm2; Radiography
PubMed: 24786129
DOI: 10.5858/arpa.2013-0030-RS -
International Archives of Medicine Jan 2014Lipoma is a benign soft tissue neoplasm that may contain mesenchymal elements, as a result of metaplastic process. Ossification in benign and malignant soft tissue...
INTRODUCTION
Lipoma is a benign soft tissue neoplasm that may contain mesenchymal elements, as a result of metaplastic process. Ossification in benign and malignant soft tissue tumors can also manifest due to metaplastic process.
CASE PRESENTATION
A 45 year old woman presented with a large thigh mass. The mass was developed one and a half year ago which insidiously increased in size and was associated with movement restriction. Radiological findings revealed soft tissue neoplasm on antero-medial aspect of thigh encircling the femur and displacing adjacent muscles. Fine trabeculations were seen in neoplasm suggestive of ossification. Excision of the mass was performed and histopathology revealed adipocytes with mature bony trabeculae possessing prominent osteoblastic rimming suggestive of ossifying lipoma.
CONCLUSION
It is important to recognize this variant of lipoma as it is associated with a better clinical outcome in contrast to most of the deep seated soft tissue neoplasms. Secondly it should also be differentiated from myositis ossificans and heterologous differentiation in other soft tissue neoplasms. We suggest an algorithmic approach to the diagnosis of ossifying soft tissue neoplasms histopathologically. Mature bony trabeculae with prominent osteoblastic rimming in a soft tissue lesion are due to a metaplastic process and should not be confused with osteosarcoma.
PubMed: 24433545
DOI: 10.1186/1755-7682-7-5 -
World Journal of Surgical Oncology Sep 2013Both giant synovial osteochondroma and parosteal osteosarcoma are rare musculo-skeletal tumors, often localized in the vicinity of the knee. Misdiagnosis of a malignant...
Both giant synovial osteochondroma and parosteal osteosarcoma are rare musculo-skeletal tumors, often localized in the vicinity of the knee. Misdiagnosis of a malignant bone tumor can entail fatal consequences. Etiology of giant synovial osteochondroma is widely unsolved but is believed to originate from synovial chondromatosis, a mostly benign metaplasia of the synovial membrane. Parosteal osteosarcoma is a low-grade surface osteosarcoma with a propensity of local recurrence and the potential of distant metastasis and therefore requiring a different therapeutical approach. We report the case of a popliteal giant osteochondroma mimicking a parosteal osteosarcoma. Relevant facts of this rare entity regarding pathogenesis, treatment, and differential diagnoses will be discussed.
Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Humans; Male; Osteochondroma; Osteosarcoma; Popliteal Cyst; Prognosis; Synovectomy; Synovial Membrane
PubMed: 24066980
DOI: 10.1186/1477-7819-11-241 -
The Bone & Joint Journal Sep 2013The aim of this study was to assess a specific protocol for the treatment of patients with a parosteal osteosarcoma of the distal femur with limb salvage involving...
The aim of this study was to assess a specific protocol for the treatment of patients with a parosteal osteosarcoma of the distal femur with limb salvage involving hemicortical resection and reconstruction using recycled pasteurised autograft and internal fixation. Between January 2000 and January 2010, 13 patients with a mean age of 26.5 years (17 to 39) underwent this procedure. All the tumours were staged according to Enneking's criteria: there were eight stage IA tumours and five stage IB tumours. The mean follow-up was 101.6 months (58 to 142), and mean post-operative Musculoskeletal Tumour Society functional score was 88.6% (80% to 100%) at the final follow-up. All the patients had achieved bony union; the mean time to union was 11.2 months (6 to 18). Local recurrence occurred in one patient 27 months post-operatively. No patient had a pulmonary metastasis. A hemicortical procedure for the treatment of a parosteal osteosarcoma is safe and effective. Precise pre-operative planning using MRI is essential in order to define the margins of resection. Although it is a technically demanding procedure, gratifying results make it worthwhile for selected patients.
Topics: Adolescent; Adult; Bone Transplantation; Female; Femoral Neoplasms; Follow-Up Studies; Humans; Male; Osteosarcoma; Pasteurization; Salvage Therapy; Transplantation, Autologous; Treatment Outcome; Young Adult
PubMed: 23997145
DOI: 10.1302/0301-620X.95B9.31433 -
Chinese Journal of Cancer Research =... Jun 2012Extraskeletal osteosarcoma (EOS) is rare and commonly arises in the retroperitoneum, limbs, head and neck. There is no significant difference between EOS and other...
Extraskeletal osteosarcoma (EOS) is rare and commonly arises in the retroperitoneum, limbs, head and neck. There is no significant difference between EOS and other malignant tumors in soft tissue. Localized pain and swelling are the common presenting symptoms. Clinical diagnosis of EOS is difficult, imaging techniques may be helpful and careful, and the histopathological analysis is necessary. The common histological variants of EOS include: osteoblastoma, chondroblastoma, and fibroblastoma, and other unusual subtypes were reported occasionally. It should be distinguished with myositis ossificans, malignant mesenchymoma, giant cell tumor and parosteal osteosarcoma. We present an EOS arising in the penis. The primary site and histological category of the tumor were extremely rare. We hope the case will be helpful to the recognition of clinical signs, iconography and histopathology of EOS.
PubMed: 23359773
DOI: 10.1007/s11670-012-0164-1 -
World Journal of Surgical Oncology Nov 2012We report the case of a parosteal osteosarcoma of the distal ulna, treated with wide resection without reconstruction. The patient developed lung metastasis and a mass...
We report the case of a parosteal osteosarcoma of the distal ulna, treated with wide resection without reconstruction. The patient developed lung metastasis and a mass in the interosseus membrane of the forearm proximally to the osteotomy. The lung mass was found to be a metastasis from parosteal osteosarcoma and the biopsy of the forearm mass revealed a myositis ossificans. The suspicion of a recurrence of parosteal osteosarcoma, already metastatic, led to a second wide resection with no reconstruction. A slice of the radial cortex was taken during this second procedure. From a histological point of view, good margins were achieved and diagnosis of myositis ossificans was confirmed. Two months later, a radius fracture occurred and a synthesis, with plate and screws, as added with poly(methyl methacrylate) (PMMA) to reconstruct the bone loss, was performed. Indication of the reconstructive technique and the complication after distal ulna resection in oncologic surgery are discussed in this paper.
Topics: Adult; Bone Neoplasms; Humans; Lung Neoplasms; Male; Myositis Ossificans; Osteosarcoma; Postoperative Complications; Radiography; Ulna
PubMed: 23194024
DOI: 10.1186/1477-7819-10-260