Case Report: Extraskeletal osteosarcoma with preceding myositis ossificans (original) (raw)
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Histopathology and Molecular Pathology of Bone and Extraskeletal Osteosarcomas
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Histopathology and Molecular Pathology of Bone and Extraskeletal Osteosarcomas 5 2. Pathologic features 2.1 Conventional osteosarcoma Conventional osteosarcoma, is solitary, arises in the medullary cavity of an otherwise normal bone, is of high grade and produces neoplastic bone with or without cartilaginous or fibroblastic components. The gross findings are variable depending on the amount of bone and other components present. It manifests as a large, metaphyseal, intramedullary and tangray-white, gritty mass. Tumours that are producing abundant mineralized bone are tangray and hard, whereas non-mineralized, cartilaginous components are glistening, gray, and may be mucinous if the matrix is myxoid, or more rubbery if hyaline in nature. It can be necrotic, hemorrhagic and cystic. Intramedullary involvement is often considerable and the tumour usually destroys the overlying cortex and forms an eccentric or circumferential soft tissue component that displaces the periosteum peripherally. In the proximal and distal portions of the tumour the raised periosteum deposits a reactive bone, known as Codman's triangle. In some cases, the tumour grows into the joint space, resulting in coating of the peripheral portions of the articular cartilage by the sarcoma. Solitary or multiple skip metastases appear as intramedullary nodules in the vicinity of or far from the main mass. Furthermore, not all osteosarcomas arise in a solitary fashion, as multiple sites may become apparent within a period of about 6 months (synchronous osteosarcoma), or multiple sites may be noted over a period longer than 6 months (metachronous osteosarcoma). Such multifocal osteosarcoma is decidedly rare, but when it occurs, it tends to be in patients, younger than 10 years. The diagnosis of osteosarcoma is based on the accurate identification of osteoid. Osteoid is unmineralized bone matrix that histologically appears as eosinophilic, dense, homogeneous, amorphous and curvilinear intercellular material, somewhat refractile. It must be distinguished from other eosinophilic extra-cellular materials such as fibrin and amyloid. Unequivocal discrimination between osteoid and non-osseous collagen may be difficult, or sometimes arbitrary (Fornasier, 1977). Non-osseous collagen tends to be linear, fibrillar and compresses between neoplastic cells. In contrast, osteoid is curvilinear with small nubs, arborisation and what appears to be abortive, lacunae formation. The thickness of the osteoid is highly variable with the 'thinnest' variant referred to as 'filigree', whereas osteoid seams are flat and thick. Osseous matrix has also the predisposition for appositional deposition upon previously existing normal bone trabeculae ('scaffolding'). Conventional osteosarcoma can produce varying amounts of cartilage and/or fibrous tissue. The algorithm is: identify the presence or absence of matrix, and if significant matrix is present, determine the matrix form and therefore subclassify into osteoblastic, chondroblastic, fibroblastic and mixed types, by virtue of the predominance of the neoplastic component.
Metachronous extraskeletal (soft tissue) epithelioid osteogenic sarcoma: a case report
Journal of Medical Case Reports
Background: Metachronous osteosarcoma is a rare form of osteosarcoma. The occurrence of metachronous tumor in soft tissue is exceedingly rare. The pathogenesis of metachronous osteosarcoma, as to whether it represents multiple true primaries or metastatic disease, is still obscure. Case presentation: A 49-year-old Indian man presented with progressively increasing swelling in his left hand of 2 months' duration. An X-ray showed a soft tissue lesion. Contrast-enhanced computed tomography showed a soft tissue mass lesion, with peripheral enhancement and central necrotic areas in radial palmar soft tissue overlying second metacarpophalangeal region with no obvious bony osteolysis. Possibilities of acute abscess, resolving hematoma, or aggressive soft tissue mass lesion were suggested. An incision biopsy showed morphological features of epithelioid osteosarcoma, which was confirmed on immunohistochemistry. A detailed history revealed that our patient was diagnosed as having osteosarcoma of his right leg 3 years previously. Based on history, radiology, morphology, and immunohistochemistry, a final diagnosis of extraskeletal (soft tissue) epithelioid osteogenic sarcoma of the left hand occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg was given. Conclusion: This is probably the first reported case of extraskeletal (soft tissue) epithelioid osteosarcoma occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg. The prognosis of metachronous skeletal osteosarcoma is poor as compared to that of relapse limited to lungs. In late metachronous osteosarcoma, combined-modality therapy comprising surgery and aggressive chemotherapy may affect long-term survival. Lifelong follow-up of surviving patients with osteosarcoma is necessary and if metachronous osteosarcoma is discovered, it should be treated with curative intent.
Small cell extraskeletal osteosarcoma: a rare case report
Rare Tumors, 2014
Extraskeletal osteosarcoma is a rare malignant mesenchymal neoplasm and its small cell variant is one among the rarest variant. This article describes a 60-year-old woman presenting with a large, lobulated, painful mass in left thigh with associated history of trauma since 18 months. Her magnetic resonance imaging showed a variegated mixed intensity lesion with associated cystic degeneration, necrosis and matrix arborizing nearby muscles. Fine needle aspiration cytology showed a small cell lesion with very scant osteoid. Tumor was excised and histopathological diagnosis was small cell osteosarcoma involving adjacent muscles and fat with sparing of lymph nodes. The aim of this article is to present the clinical, radiological, cyto-histological and immunohistochemical features of this extremely rare lesion.
Extraskeletal osteosarcoma arising in the pretibial subcutaneous tissue
European Journal of Radiology Extra, 2004
The case of a 66-year-old man with extraskeletal osteosarcoma (ESOS) arising in the pretibial subcutaneous tissue is presented. On radiographs, there were no calcifications or ossifications within the soft-tissue mass. Magnetic resonance imaging (MRI) showed the tumor to be in the subcutaneous tissue anteriorly to the patellar tendon without attachment to the bone. Histologic examination revealed a cystic hemorrhagic cavity containing necrotic and viable tumor and a large solid component. A diagnosis of chondroblastic type extraskeletal osteosarcoma was made.
The Internet journal of pathology, 2008
Extraskeletal osteosarcoma (ESOS), the soft tissue counterpart of primary skeletal osteosarcoma, is a rare tumor. Although rhabdomyosarcomatous differentiation may be seen in a variety of sarcomas, it has not been described in an ESOS. We report a case of ESOS, osteoblastic type, in the right upper extremity of a 50-year-old woman showing rhabdomyosarcomatous differentiation in the local recurrence and lung metastases, so-called malignant mesenchymoma of soft tissue. Rhabdomyoblasts, which were not observed in the initial specimen, were detected in the recurrent and metastatic tumors, which were obtained after the administration of chemotherapy with cisplatin and adriamycin. The patient died with a metastatic giant soft tissue mass occupying the inferior part of left hemithorax 17 months after the appearance of the initial tumor. We discuss the differential diagnosis of soft tissue tumors showing more than one differentiated tissue type and the factors that might play a role in the histogenesis of tumors with rhabdomyosarcomatous differentiation.
Current Problems in Diagnostic Radiology, 2020
Although rare in everyday practice, malignancies that classically arise from bone or cartilage have been reported to arise de novo in various soft tissues in the body, resulting in a diagnostic challenge for the clinician, radiologist, and pathologist. Differential diagnoses of bone tumors often depend on anatomic location of the lesion. For example, the classic location of osteosarcoma is in the metaphysis of long bones about the knee. Histologically osteosarcoma is characterized by tumor cells that directly produce osteoid, bone, or cartilaginous matrix. In extraskeletal osteosarcoma, the clinical and radiologic picture is very different from a conventional osteosarcoma. They occur in older patients, present as a soft tissue mass often coincidentally following trauma and have a worse prognosis. The imaging characteristics are often nonspecific with mineralized elements in a welldefined soft tissue mass. The mineralized elements may or may not be visible. Magnetic Resonance sequences demonstrate a well circumscribed soft tissue mass with hemorrhagic and enhancing solid components. The pathologic features of extraskeletal osteosarcoma on a microscopic scale are identical to that of skeletal lesions. Likewise, conventional chondrosarcomas present in older patients with a growing, painful soft tissue prominence most commonly involving the long tubular bones. In extraskeletal chondrosarcoma however, the presentation is in somewhat younger patients with a painful soft tissue prominence typically in the head (meninges), neck, or upper leg. The pathologic features are most often that of a myxoid chondrosarcoma which is characterized by strands of small cells over a myxoid matrix. Imaging features include chondroid matrix, heterogenous contrast enhancement, and amorphous internal calcification on Computed Tomography. On Magnetic Resonance sequences the matrix has a low signal on all sequences, and variable inhomogeneity depending on grade of the lesion. Other extraskeletal bone tumors include Ewing's sarcoma and osteoid osteoma amongst other lesions. Although these malignancies may be rare clinical entities, they often exhibit characteristic clinical, imaging, and histopathological findings although differing in treatment and prognosis. Knowledge of these and other common mimicking lesions will help guide the clinician and radiologist to make an accurate diagnosis.
Extraskeletal osteosarcoma. A clinicopathologic review of 26 cases
Cancer, 1990
Four cases of extraskeletal osteosarcoma which were treated at the National Cancer Center Hospital have been reviewed. There were three males and one female. The ages of the patients were 32, 48, 48 and 59 years. Three patients had a solitary tumor located in the lower leg, thigh or postirradiated abdominal wall. The remaining patient had multiple tumors in the ipsilateral thigh and buttock. The predominant histologic subtype was osteoblastic in two cases, chondroblastic in one and malignant fibrous histiocytoma-like in one. Only one patient with a subcutaneous tumor was free of disease 16 years after a wide local excision without chemotherapy. The other three patients, two having undergone inadequate initial surgery, and one with multiple tumors, developed pulmonary metastases within 24 months of their initial surgical treatment. All of them died of the pulmonary metastases eight, 36 and 63 months after their initial treatment. Postoperative intensive chemotherapy was given to two patients. Although both had developed metastases to the lung, they received resection of the metastases combined with additional chemotherapy, surviving for more than 24 months after the occurrence of their first metastases.