Introduction A low grade osteosarcoma Epidemiology demographics more common in females, age 30-40 location occurs on surface of metaphysis of long bones most common sites include posterior distal femur, proximal tibia, and proximal humerus 80% cases occur in the femur marrow invasion occurs in 25% of cases Prognosis 95% long term survival when local control has been achieved dedifferentiation of parosteal osteosarcoma is a poor prognostic factor invasion into the medullary cavity does not affect long-term survival Symptoms Presentation often presents as a painless mass limited joint motion can also be a presenting complaint for characteristic large posterior distal femoral lesions Imaging Radiographs heavily ossified, lobulated mass arising from cortex appears stuck onto cortex CT chest mandatory staging study used to evaluate for pulmonary metastasis MRI mandatory and must include entire involved bone helps determine soft tissue/marrow involvement and skip lesions Bone scan mandatory imaging study always hot Histology Characteristic histology low grade lesion regularly arranged normal osseous trabeculae most prominent histologic feature are the atypical spindle cells seen between regularly arranged osseous trabeculae some cellular atypia should be seen to make diagnosis Histology can be mistaken for fibrous dysplasia high rate of MDM2 amplification and ring chromosome Treatment Operative wide local surgical excision indications standard of care in most patients technique many consider geometric osteotomy of involved bone to decrease long term morbidity and retain native joint chemotherapy chemotherapy not indicated unless there is a high grade component outcomes often curative Groups & Differentials Fibrous dysplasia (similar on histology, but xrays are different) Myositis Ossificans Traumatica (juxtaposed to bone) Osteochondral exostosis (shares cortex with bone) Developmental defect at insertion of adductor magnus Bone surface lesion (cortex) Similar Histology Treated with surgery alone (2) Parosteal osteosarcoma • • Periosteal osteosarcoma • Periosteal chondroma • • Osteochonroma / MHE • • Developmental defect • Myositis ossifican • Chondrosarcoma • Adamantinoma • Chordoma • (controversial) Fibrous Dysplasia • ASSUMPTIONS: (1) Older patient is > 40 yrs; (2) assuming no impending fracture IBank Location Xray Xray CT B. scan MRI MRI Histo Case A distal femur Case B distal femur Case C prox. humerus
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.47) A 24-year-old male presents with increasing knee pain over the last 6 months. He reports that he sustained a non-contact twisting injury to the knee 7 months ago while playing softball. His knee range of motion is full and his knee is stable to varus and valgus at 0 and 30 degrees of knee flexion. There is a grade 1 Lachman examination. His dial test reveals 30 degrees of external rotation at 30 degrees of knee flexion. A radiograph is shown in Figure A. A biopsy is performed and is shown in Figure B. What is the most appropriate definitive management? Review Topic | Tested Concept QID: 4407 FIGURES: A B Type & Select Correct Answer 1 Reassurance and observation in 6 months with repeat knee radiographs 6% (364/5960) 2 Neoadjuvant external beam radiation, wide surgical resection, and adjuvant chemotherapy 5% (325/5960) 3 Wide surgical resection 47% (2818/5960) 4 Neoadjuvant chemotherapy, wide surgical resection, adjuvant chemotherapy 37% (2203/5960) 5 Neoadjuvant chemotherapy, marginal surgical resection, adjuvant chemotherapy 3% (198/5960) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.88) A 21-year-old male presents with increasing shoulder pain for the past 6 months. Radiograph, CT scan, bone scan, MRI, and histology slide are shown in Figures A through E. What is the most appropriate diagnosis? Review Topic | Tested Concept QID: 3511 FIGURES: A B C D E Type & Select Correct Answer 1 Ewing's sarcoma 2% (34/1747) 2 Periosteal osteosarcoma 27% (465/1747) 3 Parosteal osteosarcoma 59% (1039/1747) 4 Osteochondroma 7% (120/1747) 5 Myositis ossificans 5% (81/1747) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (0) Podcasts (1) Pathology⎪Parosteal Osteosarcoma Orthobullets Team Pathology - Parosteal Osteosarcoma Listen Now 9:42 min 6/4/2020 16 plays (0)