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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 -
Frontiers in Veterinary Science 2021This case report describes a rare form of malignant bone tumor in an 8-year-old Labrador retriever. This dog initially presented for evaluation of a right distal humeral...
This case report describes a rare form of malignant bone tumor in an 8-year-old Labrador retriever. This dog initially presented for evaluation of a right distal humeral mass. Radiographs of the right elbow and thorax were performed, revealing a smooth mineralized mass adjacent to the lateral aspect of the distal humerus and a 5mm pulmonary nodule. Computed tomography (CT) of the humerus and thorax showed a smooth mineralized lesion adjacent to the lateral humeral epicondyle, and a right cranial lung lobe nodule with a thin mineral rim. Surgical biopsies of both lesions were diagnostic for parosteal osteosarcoma (POSA). The dog was then treated with stereotactic body radiation therapy (SBRT) which controlled the dog's discomfort for 14 months until he became progressively painful and subsequently had his right forelimb amputated. This case report is the first to document the CT imaging characteristics of a metastatic appendicular POSA in a dog and the first dog described with POSA treated with SBRT. The dog lived for 623 days after histopathologic diagnosis and 849 days after initial presentation with pulmonary metastatic disease.
PubMed: 34504888
DOI: 10.3389/fvets.2021.715908 -
Cureus May 2022Background/Aim Oral epithelia demonstrate a broad spectrum of pre-cancerous, cancerous, and benign lesions. The aim of this study was to record and analyze the...
Background/Aim Oral epithelia demonstrate a broad spectrum of pre-cancerous, cancerous, and benign lesions. The aim of this study was to record and analyze the prevalence of various oral and intraosseous lesions, highlighting malignancies that are hard to clinically identify as such too. Materials and methods A series of 536 oral lesions were collected covering a period of 8.5 years. Epidemiological and clinico-histopathological data were stratified and analyzed retrospectively. Results According to extensive differential analysis, the male to female ratio for oral squamous cell carcinoma was estimated at 1:1, for pre-cancerous lesions at 1:2, and for lichen planus at 1:5. The prevalent diagnostic category were cysts (n = 223, 41.6%). The biological behavior of lesions differed among anatomic sites (P<0.001). Concordance between clinical suspicion of pre-cancerous or malignant lesions and histological verification was 96.4% (P<0.001). Conclusions Primary intraosseous squamous cell carcinoma, acinic cell carcinoma, clear cell myoepithelial carcinoma, aggressive osteoblastoma/parosteal osteosarcoma, and undifferentiated carcinoma raised no clinical suspicion of malignancy reflecting the importance of training in oral biopsy taking.
PubMed: 35572462
DOI: 10.7759/cureus.24956 -
Journal of the National Medical... Jan 1991We report on the case of a 24-year-old black male who presented to the orthopedic service with a parosteal osteosarcoma of the distal tibia. There have been 206 cases...
We report on the case of a 24-year-old black male who presented to the orthopedic service with a parosteal osteosarcoma of the distal tibia. There have been 206 cases reported on this tumor in all the world's literature, with the distal femur being the most common location; this case report is rare, therefore, because of the unusual location of the tumor. This article was prepared in order to familiarize the general medical community with the occurrence of the tumor and to provide some general background information and treatment recommendations for parosteal osteosarcoma.
Topics: Adult; Bone Neoplasms; Humans; Male; Osteosarcoma; Radiography; Tibia
PubMed: 1994072
DOI: No ID Found -
Modern Pathology : An Official Journal... Sep 2010Parosteal osteosarcoma and low-grade central osteosarcoma are two types of low-grade osteosarcoma that show similar clinical behaviors, histological features, and...
Parosteal osteosarcoma and low-grade central osteosarcoma are two types of low-grade osteosarcoma that show similar clinical behaviors, histological features, and genetic background (ie, amplified sequences of 12q13-15, including MDM2 and CDK4). Low-grade osteosarcoma is often confused with benign lesions, and ancillary techniques to enhance diagnostic accuracy have been awaited. This study explores the use of MDM2 and CDK4 immunohistochemistry for the histological diagnosis of low-grade osteosarcoma. We studied 23 cases of low-grade osteosarcoma from 21 patients (parosteal osteosarcoma (n=14), low-grade central osteosarcoma (n=9)) and 40 cases of benign histological mimics (myositis ossificans (n=11), fibrous dysplasia (n=14), osteochondroma (n=6), desmoplastic fibroma (n=1), florid reactive periostitis (n=4), Nora's lesion (n=3), and turret exostosis (n=1)). Low-grade osteosarcoma labeled for MDM2 in 16 cases (70%) and for CDK4 in 20 cases (87%). All low-grade osteosarcomas expressed one or both markers (100%), with 13 cases (57%) expressing both. Staining pattern was diffuse in most cases, and the majority expressed moderate or strong intensity for either antibody. MDM2/CDK4 immunostaining was shown irrespective of low-grade osteosarcoma histological subtype. In contrast, only 1 Nora's lesion out of the 40 miscellaneous benign processes showed immunoreactivity for MDM2 or CDK4. The combination of these two markers thus shows 100% sensitivity and 97.5% specificity for the diagnosis of low-grade osteosarcoma. MDM2 and CDK4 immunostains therefore reliably distinguish low-grade osteosarcoma from benign histological mimics, and their combination may serve as a useful adjunct in this difficult differential diagnosis.
Topics: Adolescent; Adult; Aged; Biomarkers, Tumor; Bone Diseases; Bone Neoplasms; Cyclin-Dependent Kinase 4; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Male; Middle Aged; Osteosarcoma; Proto-Oncogene Proteins c-mdm2; Retrospective Studies; Young Adult
PubMed: 20601938
DOI: 10.1038/modpathol.2010.124 -
Indian Journal of Surgical Oncology Sep 2020We present an atypical case of histopathology suggesting hemangioendothelioma and immunohistochemistry-proven Ewing's sarcoma in a 39-year-old lady who presented with...
We present an atypical case of histopathology suggesting hemangioendothelioma and immunohistochemistry-proven Ewing's sarcoma in a 39-year-old lady who presented with multiple stony hard swellings involving the occipital region of the scalp, right cervical lymph node, right scapular region, left infraclavicular region of the chest, right anterior abdominal wall swelling, and inner aspect of right thigh. She underwent left-sided below-knee amputation for parosteal osteosarcoma in the left distal tibia 3 years back. Palliative radiotherapy with dose of 30 Gy in 10 fractions over 2 weeks was administered to the right neck and right upper back following which she attained moderate pain relief but no reduction in swellings as was expected had it been a case of hemangioendothelioma or Ewing's sarcoma..
PubMed: 33364700
DOI: 10.1007/s13193-020-01126-2 -
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 -
BMC Musculoskeletal Disorders Dec 2023Parosteal osteosarcomas are low-grade bony malignancies that are treated primarily with surgical resection and reconstruction. This report discusses a unique case of a...
INTRODUCTION
Parosteal osteosarcomas are low-grade bony malignancies that are treated primarily with surgical resection and reconstruction. This report discusses a unique case of a pediatric patient who presented with a parosteal osteosarcoma of the distal radius causing extensive erosive mass effect and growth disturbance of the adjacent ulna. Likely due to their slow-growing nonaggressive nature, parosteal osteosarcomas have not been previously described to abut adjacent bony structures through direct contact. The patient presented in a significantly delayed manner due to social circumstances, inadvertently revealing this novel behavior. This report reviews this rare case and describes the current understanding of this tumor.
CASE PRESENTATION
The patient is a 13-year-old male who presented with a parosteal osteosarcoma of his distal radius. He presented with a palpable wrist mass and wrist stiffness. He presented in a delayed manner with advanced local disease due to social factors. Imaging revealed an osseous radial mass that abutted the ulna and likely stunted its growth. The patient ultimately underwent complex resection and allograft reconstruction of both his distal radius and ulna. Intraoperative pathology was confirmed to have negative tumor margins. Allograft reconstruction of the radius and ulna was performed utilizing patient-specific custom cutting guides. At the 6-month postoperative visit, the patient had no recurrence of the mass, minimal pain, and had almost regained range of motion of the extremities. Clinical radiographs at the 6-month postoperative visit demonstrated allograft incorporation.
CONCLUSIONS
A previously unreported case of pediatric parosteal osteosarcoma of the distal radius with erosion of the adjacent ulna through direct contact is presented. The challenges in and the importance of arriving at a definitive diagnosis in a timely manner for the proper treatment of this malignancy are emphasized.
Topics: Adolescent; Humans; Male; Bone Neoplasms; Osteosarcoma; Radius; Ulna; Upper Extremity
PubMed: 38057715
DOI: 10.1186/s12891-023-07018-0 -
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 -
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