Difference between revisions of "Osteosarcoma"

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'''Osteosarcoma''', also known as '''osteogenic sarcoma''', a malignant [[bone]] tumour.
'''Osteosarcoma''', also known as '''osteogenic sarcoma''', a malignant [[bone]] tumour. It is grouped with the [[chondro-osseous tumours]].


===General===
==General==
*Most common malignant bone tumour in children.
*Most common malignant bone tumour in children.
*May be seen in the context of [[Li-Fraumeni syndrome]].
*May be seen in the context of [[Li-Fraumeni syndrome]].
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*Terry Fox was afflicited by this tumour.
*Terry Fox was afflicited by this tumour.


====Definition====
===Definition===
*Tumour that makes osteoid.
*Tumour that makes osteoid.
**Osteoid = (extracellular) organic component of bone, normally produced by osteoblasts (cells which make bone matrix).
**Osteoid = (extracellular) organic component of bone, normally produced by osteoblasts (cells which make bone matrix).


===Gross===
==Gross==
Classic locations:<ref name=Ref_TN2007_OR43>{{Ref TN2007|OR43}}</ref>
Classic locations:<ref name=Ref_TN2007_OR43>{{Ref TN2007|OR43}}</ref>
*Distal femur ~ 45%.  
*Distal femur ~ 45%.  
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*Proximal humerous ~ 15%.
*Proximal humerous ~ 15%.


===Microscopic===
==Microscopic==
Features:
Features:
*Cells with malignant features (e.g. nuclear membrane irregularities, marked nuclear size differences, mitoses) surrounded by delicate strands of osteoid.
*Cells with malignant features (e.g. nuclear membrane irregularities, marked nuclear size differences, mitoses) surrounded by delicate strands of osteoid.
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*Large (multinucleated) osteoclast-like giant cells may be seen.<ref>{{cite journal |author=Papalas JA, Balmer NN, Wallace C, Sangueeza OP |title=Ossifying dermatofibroma with osteoclast-like giant cells: report of a case and literature review |journal=Am J Dermatopathol |volume=31 |issue=4 |pages=379-83 |year=2009 |month=June |pmid=19461244 |doi=10.1097/DAD.0b013e3181966747 |url=}}</ref>
*Large (multinucleated) osteoclast-like giant cells may be seen.<ref>{{cite journal |author=Papalas JA, Balmer NN, Wallace C, Sangueeza OP |title=Ossifying dermatofibroma with osteoclast-like giant cells: report of a case and literature review |journal=Am J Dermatopathol |volume=31 |issue=4 |pages=379-83 |year=2009 |month=June |pmid=19461244 |doi=10.1097/DAD.0b013e3181966747 |url=}}</ref>


=====Images=====
====Images====
<gallery>
<gallery>
Image:Osteosarcoma_-_intermed_mag.jpg | Osteosarcoma - intermed. mag. (WC)
Image:Osteosarcoma_-_intermed_mag.jpg | Osteosarcoma - intermed. mag. (WC)
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*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843711/figure/F3/ Lace-like osteoid of osteosarcoma (nih.gov)].<ref name=pmid20181254>{{Cite journal  | last1 = Papandreou | first1 = C. | last2 = Skopelitou | first2 = A. | last3 = Kappes | first3 = G. | last4 = Daouaher | first4 = H. | title = Primary osteosarcoma of the urinary bladder treated with external radiotherapy in a patient with a history of transitional cell carcinoma: a case report. | journal = J Med Case Rep | volume = 4 | issue =  | pages = 70 | month =  | year = 2010 | doi = 10.1186/1752-1947-4-70 | PMID = 20181254 | PMC = 2843711 }}</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843711/figure/F3/ Lace-like osteoid of osteosarcoma (nih.gov)].<ref name=pmid20181254>{{Cite journal  | last1 = Papandreou | first1 = C. | last2 = Skopelitou | first2 = A. | last3 = Kappes | first3 = G. | last4 = Daouaher | first4 = H. | title = Primary osteosarcoma of the urinary bladder treated with external radiotherapy in a patient with a history of transitional cell carcinoma: a case report. | journal = J Med Case Rep | volume = 4 | issue =  | pages = 70 | month =  | year = 2010 | doi = 10.1186/1752-1947-4-70 | PMID = 20181254 | PMC = 2843711 }}</ref>


====Subtypes====
===Subtypes===
Subtypes:<ref name=Ref_WMSP638>{{Ref WMSP|638}}</ref><ref>URL: [http://bestpractice.bmj.com/best-practice/monograph/780/basics/classification.html http://bestpractice.bmj.com/best-practice/monograph/780/basics/classification.html]. Accessed on: 7 April 2011.</ref>
Subtypes:<ref name=Ref_WMSP638>{{Ref WMSP|638}}</ref><ref>URL: [http://bestpractice.bmj.com/best-practice/monograph/780/basics/classification.html http://bestpractice.bmj.com/best-practice/monograph/780/basics/classification.html]. Accessed on: 7 April 2011.</ref>
*Conventional osteosarcoma (high grade).
*Conventional osteosarcoma (high grade).
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*Telangiectatic.
*Telangiectatic.


=====Chondroblastic osteosarcoma=====
====Chondroblastic osteosarcoma====
*Chondroid matrix present - may be prominent; osteoid may be a minor component.
*Chondroid matrix present - may be prominent; osteoid may be a minor component.
*May be confused with [[chondrosarcoma]].
*May be confused with [[chondrosarcoma]].


=====Fibroblastic osteosarcoma=====
====Fibroblastic osteosarcoma====
*[[Undifferentiated pleomorphic sarcoma]]-like/[[MFH]]-like.
*[[Undifferentiated pleomorphic sarcoma]]-like/[[MFH]]-like.


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*[http://path.upmc.edu/cases/case44.html Fibroblastic osteosarcoma (upmc.edu)].
*[http://path.upmc.edu/cases/case44.html Fibroblastic osteosarcoma (upmc.edu)].


=====Low-grade central osteosarcoma=====
====Low-grade central osteosarcoma====
*Well-formed bone.
*Well-formed bone.
*Usu. minimal nuclear atypia.
*Usu. minimal nuclear atypia.
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*[[Fibrous dysplasia]].<ref name=inwards>{{cite journal |author=Inwards, CY |title=Low-grade central osteosarcoma versus fibrous dysplasia |journal=Pathology Case Reviews |volume=6 |issue=1 |pages=22-27 |year=2001 |pmid= |doi= |url= http://journals.lww.com/pathologycasereviews/Fulltext/2001/01000/Low_Grade_Central_Osteosarcoma_Versus_Fibrous.5.aspx }}</ref>
*[[Fibrous dysplasia]].<ref name=inwards>{{cite journal |author=Inwards, CY |title=Low-grade central osteosarcoma versus fibrous dysplasia |journal=Pathology Case Reviews |volume=6 |issue=1 |pages=22-27 |year=2001 |pmid= |doi= |url= http://journals.lww.com/pathologycasereviews/Fulltext/2001/01000/Low_Grade_Central_Osteosarcoma_Versus_Fibrous.5.aspx }}</ref>


=====Telangiectatic osteosarcoma=====
====Telangiectatic osteosarcoma====
*Rare.<ref name=omim21339678>{{Cite journal  | last1 = Patibandla | first1 = MR. | last2 = Uppin | first2 = SG. | last3 = Thotakura | first3 = AK. | last4 = Panigrahi | first4 = MK. | last5 = Challa | first5 = S. | title = Primary telangiectatic osteosarcoma of occipital bone: a case report and review of literature. | journal = Neurol India | volume = 59 | issue = 1 | pages = 117-9 | month =  | year =  | doi = 10.4103/0028-3886.76891 | PMID = 21339678 }}</ref>
*Rare.<ref name=omim21339678>{{Cite journal  | last1 = Patibandla | first1 = MR. | last2 = Uppin | first2 = SG. | last3 = Thotakura | first3 = AK. | last4 = Panigrahi | first4 = MK. | last5 = Challa | first5 = S. | title = Primary telangiectatic osteosarcoma of occipital bone: a case report and review of literature. | journal = Neurol India | volume = 59 | issue = 1 | pages = 117-9 | month =  | year =  | doi = 10.4103/0028-3886.76891 | PMID = 21339678 }}</ref>
*Extremely vascular.
*Extremely vascular.
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*[[Aneurysmal bone cyst]].
*[[Aneurysmal bone cyst]].


=====Parosteal osteosarcoma=====
====Parosteal osteosarcoma====
*Arise from surface of bone.<ref>{{Ref WHOSTAB|279}}</ref>
*Arise from surface of bone.<ref>{{Ref WHOSTAB|279}}</ref>
*Low grade.<ref name=pmid16896870>{{Cite journal  | last1 = Carrle | first1 = D. | last2 = Bielack | first2 = SS. | title = Current strategies of chemotherapy in osteosarcoma. | journal = Int Orthop | volume = 30 | issue = 6 | pages = 445-51 | month = Dec | year = 2006 | doi = 10.1007/s00264-006-0192-x | PMID = 16896870 | PMC = 3172747 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172747/?tool=pubmed}}</ref>
*Low grade.<ref name=pmid16896870>{{Cite journal  | last1 = Carrle | first1 = D. | last2 = Bielack | first2 = SS. | title = Current strategies of chemotherapy in osteosarcoma. | journal = Int Orthop | volume = 30 | issue = 6 | pages = 445-51 | month = Dec | year = 2006 | doi = 10.1007/s00264-006-0192-x | PMID = 16896870 | PMC = 3172747 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172747/?tool=pubmed}}</ref>
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*[[Fibrous dysplasia]].{{fact}}
*[[Fibrous dysplasia]].{{fact}}


=====Periosteal osteosarcoma=====
====Periosteal osteosarcoma====
*Intermediate grade.<ref name=pmid16896870/>
*Intermediate grade.<ref name=pmid16896870/>


=====Small cell osteosarcoma=====
====Small cell osteosarcoma====
*May mimic (other) [[small round cell tumours]].
*May mimic (other) [[small round cell tumours]].


=====Secondary osteosarcoma=====
====Secondary osteosarcoma====
Arises in the context of something else - causes:
Arises in the context of something else - causes:
*[[Paget disease of the bone]] (~80% of secondary osteosarcomas)
*[[Paget disease of the bone]] (~80% of secondary osteosarcomas)

Revision as of 19:50, 24 August 2013

Osteosarcoma, also known as osteogenic sarcoma, a malignant bone tumour. It is grouped with the chondro-osseous tumours.

General

Trivia:

  • Terry Fox was afflicited by this tumour.

Definition

  • Tumour that makes osteoid.
    • Osteoid = (extracellular) organic component of bone, normally produced by osteoblasts (cells which make bone matrix).

Gross

Classic locations:[1]

  • Distal femur ~ 45%.
  • Proximal tibia ~ 20%.
  • Proximal humerous ~ 15%.

Microscopic

Features:

  • Cells with malignant features (e.g. nuclear membrane irregularities, marked nuclear size differences, mitoses) surrounded by delicate strands of osteoid.
    • Osteoid on H&E: pink, homogenous, "glassy".
    • Tumours typically very cellular - when compared to normal bone.
  • Large (multinucleated) osteoclast-like giant cells may be seen.[2]

Images

  • Osteosarcoma - intermed. mag. (WC)

  • Osteosarcoma - very high mag. (WC)

  • Small cell osteosarcoma - intermed. mag. (WC)

  • Small cell osteosarcoma - high mag. (WC)

www:

Subtypes

Subtypes:[4][5]

How to remember:

  • Convention FOC = fibroblastic, osteogenic, chondroblastic.
  • Low-grade central.
  • High-grade surface.
  • Parosteal.
  • Periosteal.
  • Small cell.
  • Secondary.
  • Telangiectatic.

Chondroblastic osteosarcoma

  • Chondroid matrix present - may be prominent; osteoid may be a minor component.
  • May be confused with chondrosarcoma.

Fibroblastic osteosarcoma

Images:

Low-grade central osteosarcoma

  • Well-formed bone.
  • Usu. minimal nuclear atypia.

DDx:

Telangiectatic osteosarcoma

  • Rare.[7]
  • Extremely vascular.
  • Prognosis similar to other types of osteosarcoma.[8]

Important radiologic DDx:

Parosteal osteosarcoma

  • Arise from surface of bone.[9]
  • Low grade.[10]
  • Well-formed bone.

DDx:

Periosteal osteosarcoma

  • Intermediate grade.[10]

Small cell osteosarcoma

Secondary osteosarcoma

Arises in the context of something else - causes:

Images:

See also

References

  1. ↑ Greenwald, J.; Heng, M. (2007). Toronto Notes for Medical Students 2007 (2007 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. OR43. ISBN 978-0968592878.
  2. ↑ Papalas JA, Balmer NN, Wallace C, Sangueeza OP (June 2009). "Ossifying dermatofibroma with osteoclast-like giant cells: report of a case and literature review". Am J Dermatopathol 31 (4): 379-83. doi:10.1097/DAD.0b013e3181966747. PMID 19461244.
  3. ↑ Papandreou, C.; Skopelitou, A.; Kappes, G.; Daouaher, H. (2010). "Primary osteosarcoma of the urinary bladder treated with external radiotherapy in a patient with a history of transitional cell carcinoma: a case report.". J Med Case Rep 4: 70. doi:10.1186/1752-1947-4-70. PMC 2843711. PMID 20181254. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843711/.
  4. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 638. ISBN 978-0781765275.
  5. ↑ URL: http://bestpractice.bmj.com/best-practice/monograph/780/basics/classification.html. Accessed on: 7 April 2011.
  6. ↑ Inwards, CY (2001). "Low-grade central osteosarcoma versus fibrous dysplasia". Pathology Case Reviews 6 (1): 22-27. http://journals.lww.com/pathologycasereviews/Fulltext/2001/01000/Low_Grade_Central_Osteosarcoma_Versus_Fibrous.5.aspx.
  7. ↑ Patibandla, MR.; Uppin, SG.; Thotakura, AK.; Panigrahi, MK.; Challa, S.. "Primary telangiectatic osteosarcoma of occipital bone: a case report and review of literature.". Neurol India 59 (1): 117-9. doi:10.4103/0028-3886.76891. PMID 21339678.
  8. ↑ Weiss, A.; Khoury, JD.; Hoffer, FA.; Wu, J.; Billups, CA.; Heck, RK.; Quintana, J.; Poe, D. et al. (Apr 2007). "Telangiectatic osteosarcoma: the St. Jude Children's Research Hospital's experience.". Cancer 109 (8): 1627-37. doi:10.1002/cncr.22574. PMID 17351949.
  9. ↑ The International Agency for Research on Cancer (Editors: Fletcher, C.D.M.; Unni, K. Krishnan; Mertens, F.) (2006). Pathology and Genetics of Tumours of Soft Tissue and Bone (IARC WHO Classification of Tumours) (3rd ed.). World Health Organization. pp. 279. ISBN 978-9283224136.
  10. ↑ 10.0 10.1 10.2 Carrle, D.; Bielack, SS. (Dec 2006). "Current strategies of chemotherapy in osteosarcoma.". Int Orthop 30 (6): 445-51. doi:10.1007/s00264-006-0192-x. PMC 3172747. PMID 16896870. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172747/.
  11. ↑ URL: http://www.rsna.org/REG/publications/rg/afip/privateM/1997/0017/0005/1205/6.htm. Accessed on: 8 April 2011.
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