Osteosarcoma DR: Gehan mohamed
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Osteosarcoma
04/23/17
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Definition Osteosarcoma is an aggressive malignant neoplasm arising from primitive transformed cells of mesenchymal origin (and thus a sarcoma) that exhibit osteoblastic differentiation and produce malignant osteoid. It is the most common histological form of primary bone cancer in age 12-25yrs. 3
Epidemiology
Male more than female at any age but 75% of cases appear at age 12-25yrs
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Risk factors: Radiation exposure Patients who survive after taking therapy for another Cancer. Retinoblastoma(malignant tumor arising from retina of eye). 5
Sites of predlection: Osteosarcoma :It originates more frequently in the metaphyseal region of tubular long bones, with 42% occurring in the femur
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Skeletal distribution : most common at Knee region
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osteosarcoma
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Histopathologic variants 1. Conventional: osteoblastic, chondroblastic, fibroblastic 2. Multifocal 3. Telangiectatic 4. Small cell 5. Intraosseous well-differentiated 6. Intracortical 7. Periosteal 8. Paraosteal 9. High-grade surface 10. Extraosseous 9
Diagnosis of osteosarcoma Clinical examiation Radiologic examinatiom Biopsy for histopathology
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Clinical Presentation Painful mass arising from bone Metastasize early
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Plain Xray The area of tumor mass may be Lytic, sclerotic or mixed
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In x – ray we can see Codman triangle
Codman triangle is a term used to describe the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone. sun-burst" appearance on X-ray examination due to the tumor spicules of calcified bone radiating in right angles 13
Codman triangle
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Codman triangle
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Local CT MRI +/- Angiogram
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Systemic Bone scan CT Chest
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Osteosarcoma : it is formed of Spindle shaped cells showing malignant criteria in form of pleomorphism,hyperchromasia, abnormal mitosis, giant cells . In between spindle cells there is malignant osteoid.
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Differential Dx Giant Cell Tumor Aneursymal Bone Cyst Ewings tumor Osteoblastoma Metastasis Lymphoma
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