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 Highly malignant tumor.

 Arises within the bone and spreading rapidly outward.


 Predominantly in children and adolescents.
 Mostly involves the long bone metaphyses.
Etiology

 Rapid bone growth

 Environmental factors( exposure to radiation)

 Genetic predisposition(Paget disease, fibrous


dysplasia, enchondromatosis, and hereditary multiple
exostoses and retinoblastoma)
common sites
 femur (42%, 75% of which are in the distal femur)
 tibia (19%, 80% of which are in the proximal tibia)
 humerus (10%, 90% of which are in the proximal
humerus).
 the skull and jaw (8%)
 pelvis (8%).
Clinical features
 Pain .(constant, worse at night)
 Lump.
 Pathological fracture.(telangiectatic type)
 Physical examination findings
1. Mass(may be tender and warm)
2. Decreased range of motion
3. Lymphadenopathy
4. Respiratory findings
Imaging Studies
plain x -ray

 Osteosarcoma lesions
1. purely osteolytic ( 30% )
2. purely osteoblastic (45%)
3. a mixture of both.

 Hazy osteolytic areas may alternate with dense osteoblastic


areas.
 The endosteal margin is poorly defined.
 “sunburst” effect(As the tumour mass expands new bone
forms along vascular channels)
 Codman’s triangle.
CT scanning
 helps delineate the location and extent of the tumor
and is critical for surgical planning.

 obtain the CT scan of the chest before performing a


biopsy to avoid ambiguity that can arise from
postanesthesia atelectasis.
MRI
 The best method to assess the extent of intramedullary
disease as well as associated soft-tissue masses and
skip lesions.
 The single most important study for accurate surgical
staging of the lesion with use of the Enneking staging
system.
Radionuclide bone scanning with
technetium-99 (99m Tc
 It is important to evaluate for the presence of
metastatic or multifocal disease with a bone scan.
Osteosarcoma with interrupted
periosteal rection and Codman
triangle proximally. There is
periosteal bone formation
perpendicular to the cortical
bone and extensive bony matrix
formation by the tumor itself.
 The serum alkaline phosphatase may be raised
(osteoblastic tumors )but is often normal in the lytic
examples.
 A rise in alkaline phosphatase following excision may
herald a recurrence.
 Lactate dehydrogenase (to monitor recurrence)
 Beta human chorionic gonadotropin
Pathology
 Situated in the metaphysis of a long bone.
 Areas of bone loss and cavitation alternate with dense
patches of abnormal new bone.
 Extends within the medulla and across the physeal
plate.
 high-grade, anaplastic tumors
 Osteoblastic, chondroblastic, and fibroblastic
differentiation is commonly admixed
 may be plasmacytoid, epitheloid, spindled, or oval.
 Normalization(tendency of the osteoblasts to become
smaller and less pleomorphic as they get incorporated
into the osteoid)
 Catilages cells or fibroblastics tissue with little or no
osteoid.
Medical Therapy

 neoadjuvant (preoperative) chemotherapy has been


found not only to facilitate subsequent surgical
removal by causing tumor shrinkage.
 Patients receiving methotrexate should not be given
folate supplementation or Bactrim, both of which
interfere with the effects of methotrexate.
Surgical Therapy

 definitive resection- margins on all sides of the tumor


must contain normal tissue (wide margin).
 Amputation may be the treatment of choice in some
circumstances.
 If possible, a number of options exist for limb-salvage
reconstruction, which must be chosen based on
individual considerations, as follows:
1. Autologous bone graft( may be vascularized or
nonvascularized)
2. Allograft
3. Prosthesis
4. Rotationplasty
Differential diagnosis
 Osteoblastomas
 Fracture Callus
 Giant cell tumor (GCT)
 Malignant Fibrous Histiocytoma
 Osteogenic Melanoma

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