Local recurrence of a parosteal osteosarcoma 21 years after incomplete resection (original) (raw)
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Late Recurrence in Primary Region of Parosteal Osteosarcoma: A Case Report
Pediatric Hematology and Oncology, 2008
Recurrence in patients with osteosarcoma after 5 years is a rare condition and has been infrequently reported. Here, the authors present a case of conventional parosteal osteosarcoma that had relapsed 17 years after diagnosis. To their knowledge, this is one of the latest recurrence times in the primary region of osteosarcoma.
Parosteal osteosarcoma is a rare low-grade bone tumour. The operation material must undergo a careful patohistological analysis, because the extent of invasion of the medullar cavity and most probably the extent of dedifferentiated areas determines the prognosis and occurrence of local recurrence and metastases. Patients and methods. In this retrospective clinical study, 7 cases of parosteal osteosarcoma of the bone have been analyzed. Six patients were with parosteal osteosarcoma and one with periosteal osteosarcoma. The study was performed at the Clinic for Orthopedic Surgery in Skopje, Macedonia, from 1995Macedonia, from to 2006 This tumour represents 1.5% of all 467 patients with primary bone tumours treated at the Clinic in the 12 year period. The age of 7 patients (3 female and 4 male) ranged from 8 to 39 years (median 27). The history analysis of the patients showed the misinterpreted diagnosis in 57% of the cases, with 71.4 % rate of local recurrence, 28.7% of metastases and 28.7% of mortality. The follow-up varied from 7 months to 9 years (median 37 months). Results. The clinical and histopathological findings of this study (same as those reviewed in the literature) confirmed the occurrence of two biologically different types of parosteal osteosarcoma: the predominant type is originally "benign" but has a definite malignant potential, causing metastases after the long symptom-free interval. The other type is highly malignant from the beginning. Conclusions. The compartmental, radical "en bloc" resection, followed by the regular review of the patients, is recommended for the low malignant type, however, the radical surgery, followed by chemotherapy, is recommended for the highly malignant tumours.
Radiology and Oncology, 2007
Background. Parosteal osteosarcoma is a rare low-grade bone tumour. The operation material must undergo a careful patohistological analysis, because the extent of invasion of the medullar cavity and most probably the extent of dedifferentiated areas determines the prognosis and occurrence of local recurrence and metastases. Patients and methods. In this retrospective clinical study, 7 cases of parosteal osteosarcoma of the bone have been analyzed. Six patients were with parosteal osteosarcoma and one with periosteal osteosarcoma. The study was performed at the Clinic for Orthopedic Surgery in Skopje, Macedonia, from 1995 to 2006. This tumour represents 1.5% of all 467 patients with primary bone tumours treated at the Clinic in the 12 year period. The age of 7 patients (3 female and 4 male) ranged from 8 to 39 years (median 27). The history analysis of the patients showed the misinterpreted diagnosis in 57% of the cases, with 71.4 % rate of local recurrence, 28.7% of metastases and 28.7% of mortality. The follow-up varied from 7 months to 9 years (median 37 months). Results. The clinical and histopathological findings of this study (same as those reviewed in the literature) confirmed the occurrence of two biologically different types of parosteal osteosarcoma: the predominant type is originally "benign" but has a definite malignant potential, causing metastases after the long symptom-free interval. The other type is highly malignant from the beginning. Conclusions. The compartmental, radical "en bloc" resection, followed by the regular review of the patients, is recommended for the low malignant type, however, the radical surgery, followed by chemotherapy, is recommended for the highly malignant tumours.
Clinical outcome of parosteal osteosarcoma
Journal of Surgical Oncology, 2008
Background: Parosteal osteosarcoma is a rare type of osteosarcoma with distinct characteristics. Clinical outcome of 21 patients was analyzed to assess the predictive relevance of surgical margin, intramedullary tumor extension and histologic grade. Methods: There were 5 mens and 16 womens with an average age of 26 years. Average follow-up was 9.1 years (range 2.5-22.1). Most common sites were distal femur (15) and proximal humerus (2). No patient presented with metastasis. Surgical margin was wide in 13 and marginal in 8. Intramedullary extension was seen in 10 patients (48%). Focal high-grade 2 and 3 tumors were seen in 11 (52%) and 3 (14%) patients respectively. Results: Twenty patients (95%) were alive without disease. Two (10%) had relapse, one with local recurrence and another with local recurrence and lung metastasis. Of eight marginal procedures performed, 2 turned out to have histologically tumor-positive margins, both of whom later developed relapses. All patients with histologically negative margins remained disease-free. Presence of intramedullary extension and focal highgrade tumor was not significantly associated with relapse. Conclusions: A marginal but histologically negative margin of excision appears adequate for parosteal osteosarcoma. However, long-term follow-up is warranted for monitoring of rare incidences of local recurrences or distant metastases.
In this retrospective clinical study, 6 cases of osteosarcoma of the bone have been analyzed. Five patients were with parosteal osteosarcoma and one with periosteal osteosarcoma. The study was performed at the Clinic for Orthopaedic Surgery in Skopje, Macedonia, from 1995 to 2005. This tumor represents 1.5 % of all primary bone tumors treated at the Clinic in the 11 year period. The age of the 6 patients (2 female and 4 male) ranged from 8 to 39 years (average 23. 8). The history analysis of the patients showed misinterpreted diagnosis in 50 % of the cases, with 83.3 % rate of local recurrence, 33.3 % of metastases and 33.3 % of mortality. Follow-up varied from 11 months to 9 years (average 4.5). The clinical and histopathological findings (identical with those reviewed in the literature) confirmed occurrence of two biologically different types of parosteal osteosarcoma: predominant type is originally "benign" but has a definite malignant potential, causing metastases after long symptom-free interval. The other type is highly malignant from the beginning. More radical surgery is recommended for the latter category of tumors, followed by chemotherapy. Compartmental, radical "en bloc" resection, followed by regular review of the patients, is recommended for the former (Tab. 1, , Ref. 20). Full Text (Free, PDF) www.bmj.sk.
Parosteal Osteosarcoma: A Benign-Looking Tumour, Amenable to a Variety of Surgical Reconstruction
International Journal of Surgical Oncology, 2020
Osteosarcoma arising from cortical surface is classified into parosteal, periosteal and high-grade surface osteosarcoma. Along the spectrum, parosteal osteosarcoma occupies the well-differentiated end. It is a relatively rare disease entity, comprised only 4% of all osteosarcomas and barely reported in the literature. The objective of this study is to describe cases of parosteal osteosarcoma as well as a variety of treatment options amenable to such entity. Six cases of parosteal osteosarcoma were identified based on histopathological reports in a tertiary referral hospital in Jakarta, Indonesia between January 2001 and December 2019. The mean age was 29.8 years old; four of them (66.7%) were male. Distal end of femur was the most commonly involved bone (five cases, 83.3%). The patients were treated with wide excision followed by several different reconstruction methods: replacement with endoprosthesis, extracorporeal irradiation, knee arthrodesis, or prophylactic fixation. One of o...
Journal of Solid Tumors, 2016
Objective: Parosteal Osteosarcoma (PO) is an uncommon variant of osteosarcoma. Diagnosing PO is important due to its malignant nature but the diversity of histologic features makes it challenging by adding a number of soft tissue, bony and cartilaginous lesions into the list of differential diagnosis. Our aim was to study the clinicopathologic and histological features of PO with emphasis on features helpful in its discrimination from other mimicking lesions. Methods: We reviewed 23 cases of PO diagnosed in our institution between January 2001 and August 2015. Results: Femur was the most commonly involved bone (68.2%) along with other long bones and rib in a single case. Soft tissue component was graded as Grade1 in 9(39%), Grade2 in 8(34.7%) and Grade3 in 4(17.3%) cases. Bony component was seen either in combination of or exclusively as parallel streams and interconnected trabeculae (mosaic-pattern). Out of 9 cases with cartilage component, 3 showed a cartilage cap. 2(8.6%) cases showed dedifferentiation into osteosarcoma. Conclusion: PO should always be considered in the differential diagnosis of every lesion arising from the bone surface. Knowledge of the variations in histologic features helps to reach the correct diagnosis which should never be made without radiological correlation.
Parosteal osteosarcoma: radiologic-pathologic correlation with emphasis on CT
American Journal of Roentgenology, 1987
Parosteal osteosarcoma, a distinct entity in which the neoplasm arises on the bone surface, presents characteristic features. Thorough radiologic and histologic evaluation and early definitive surgery usually result in a favorable prognosis and make limb salvage feasible in many adult patients. Twenty-six patients with proven parosteal osteosarcoma were seen at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston.
Parosteal osteosarcoma: Case report and review of the literature
Head & Neck, 2007
Background. The majority of osteosarcoma cases of the head and neck are high-grade lesions. We present a case and discuss the diagnostic and therapeutic implications of a rare low-grade parosteal osteosarcoma of the maxilla. Methods. A 32-year-old man presenting to the Head and Neck Surgical Oncology clinic with a 1-year history of a firm palatal mass. Evaluation clinically and radiographically raised the suspicion of an osteosarcoma. Results. A partial maxillectomy revealed a parosteal osteosarcoma with negative margins. No adjuvant therapy was recommended, and the patient remains without evidence of local recurrence after 3 years. Conclusions. Parosteal osteosarcomas of the head and neck region are rare, low-grade variants of osteosarcoma, but have the potential to recur with simple local excision. Clinical and radiographic features are diagnostically helpful. Definitive diagnosis comes from histopathology, and wide local resection should be employed as the optimal treatment. V
Local Recurrence of Parosteal Osteosarcoma Adjacent to a Prosthesis after 20 Years: A Case Report
Journal of Orthopaedic Surgery, 2004
We describe the treatment of an uncommonly late presentation of a recurrent parosteal osteosarcoma of the distal femur. The osteosarcoma had originally been detected 20 years earlier, and had been treated with wide excision and mega-prosthesis to reconstruct the femur. The tumour recurred in close proximity to the femur prosthesis and encased half the femoral stem. Because there was a large piece of metal at the site of recurrence, which might have interfered with computed tomography and magnetic resonance imaging, ultrasonography was used to locate the lesion. The tumour was successfully treated with wide local re-excision. This case emphasises the importance of the long-term follow-up of patients with parosteal osteosarcoma.