Osteosarcoma

Agung Rondonuwu

Tumour
Cell type

Benign

Malignant

Bone

Osteoid osteoma

Osteosarcoma

Cartilage

Chondroma
Osteochondroma

Chondrosarcoma

Fibrous tissue

Fibroma

Fibrosarcoma

Marrow

Haemangioma

Angiosarcoma

Uncertain

Giant cell tumour

Malignant giant cell tumour

Imaging
Plain x-ray are still the most usefull of all imaging techniques. There may be
an obvious abnormality in the bone cortical thickening, a discrete lump, a
cyst or ill defined destruction.
CT Scan
MRI

laboratory
Erythrocyte sedimentation rate
Serum alkaline phosphatese

Staging of lesion
Aggressiveness
Spread: metastases
Surgical stage:
Stages 1: all low grade sarcomas
Stage 2: histologically high grade lesion
Stage 3: sarcomas which have metastasized

Treatment
Tumour ecision
Intracapsular (intralesional) excision and curettage
Marginal excision
Wide excision

Radical resection
Amputation
Multi agent chemotherapy

OSTEOSARCOMA
Definition:
Highly malignant tumour arising within the bone and spreading rapidly
outwards of the periosteum and surroundoing soft tissues
It is said to occur predominantly in children and adolescents

A.K.A:
Osteogenic Sarcoma
Incidence:
More common in male adolescents
Common occurs between ages 10 and 25 years old

Risk and Predisposing Factors:

The cause is not known.
In some cases, osteosarcoma runs in families, and at least one gene has been
linked to increased risk.
This gene is also associated with familial retinoblastoma, a cancer of the eye
that occurs in children. Presence of certain rare, inherited cancers,such as the
following:
tumor of the retina that usually occurs in children younger than 4 years old.
teenage growth spurts
being tall for a specific age
previous treatment with radiation for another cancer, especially at a youngage
or with high doses of radiation
presence of a benign (non-cancerous) bone disease

Manifestations:
Localized pain at the site of the tumor
Swelling, warmth, and redness caused by the vascularity of thetumor
Bone pain
Fracture
Limitation of motion
Pain when lifting (if the tumor is in the arm)
Muscle atrophy

 Stages of osteosarcoma
Once osteosarcoma has been found, more tests may be done to find out
if cancer cells have spread to other parts of the body. This is called staging.
At present, there is no staging system for osteosarcoma.

Instead, most patients are grouped depending on whether cancer is

foundin only one part of the body (localized disease) or whether the
cancer hasspread from one part of the body to another (metastatic
disease).
The following groups are used for osteosarcoma:

 1.Localized osteosarcoma
The cancer cells have not spread beyond the bone or near by tissue in which the cancer
began.
2.Metastatic osteosarcoma
The cancer cells have spread from the bone in which the cancer began to other parts of
the body. The cancer most often spreads to the lungs. It may also spread to other bones.
In multifocal osteosarcoma, tumors appear in 2 or more bones, but have not spread to the
lungs.
3.Recurrent
Recurrent disease means that the cancer has come back(recurred) after it has been
treated. It may come back in the tissues where it first started or it may come back in
another part of the body. Osteosarcoma most often recurs in the lung. When
osteosarcoma recurs, it is usually within 2 to 3 years after treatment is completed. Later
recurrence is possible, but rare

Pathologi
The tumour is usually situated in the metaphysis of a long bone, where it
destroyes and replaces normal bone
Areas of bone loss and cavitation alternate with dense patches of
abnormal new bone
The tumour extends within the medulla and across the physeal plate. There
may be obvious spread into the soft tissues with ossification at the periosteal
margins and streaks of new bone extending into the extra osseous mass

Management:
Medical:
ChemotherapyHigh-dose methotrexate with leucovorincitrovorum factor
rescue Doxorubicin (Adriamycin)combinations of bleomycin, actinomycin,
cyclophosphamide(Cytoxan),ifosfamide(Ifex), and cisplatin are used
Carboplatin (Paraplatin)Surgical
Amputation of affected extremity
In most cases, surgery can remove the tumor while sparing the affected
limb (this is called limb-salvage surgery)

Variants of osteosarcoma
Parosteal osteosarcoma
Low grade sarcoma, situated on the surface of one tubular bones, usually
at the distal femoral or proximal tibial metaphysis
Slowly enlarging mass near the bone end

At biopsy the tumour appears as a hard mass. On microscopic examination

the lesion consists of well formed bone but without any regular trabecular
arrangement. The spaces between trabeculae are filled with cellular
fibroblastic tissue; a few atypical cells and miotic figures can usually be
found
Treatment: for a low grade parosteal osteosarcoma, wide excision without
adjuvant therapy is sufficient to ensure a recurrence rate below 10%

 Periosteal osteosarcoma
This rare tumour is quite distinct from parosteal osteosarcoma. It is more like
an intramedullary osteosarcoma, but situated on the surface of the bone
X-ray: a superficial defect of the cortex, but ct and mri may reveal a larger
soft tissue mass

Radiology
X-ray: osteolytic areas may alternate with unusually dense osteoblastic
areas.
Sunburst effect
Codman triangle