Osteosarcoma

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Osteosarcoma, also known as osteogenic sarcoma, a malignant bone tumour.

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

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.