Osteosarcoma

Osteosarcoma
ICD-10	C40-C41
ICD-9	170
ICD-O:	Template:ICDO
OMIM	259500
DiseasesDB	9392
MedlinePlus	001650
MeSH	D012516

Osteosarcoma Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Osteosarcoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Biopsy
X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Osteosarcoma On the Web
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American Roentgen Ray Society Images of Osteosarcoma All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Osteosarcoma
CDC on Osteosarcoma
Osteosarcoma in the news
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Directions to Hospitals Treating Osteosarcoma
Risk calculators and risk factors for Osteosarcoma

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Diagnosis

History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics

Treatment

Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies

Prognosis

• Prognosis is separated into three groups.

• Stage I osteosarcoma is rare and includes parosteal osteosarcoma or low-grade central osteosarcoma. It has an excellent prognosis (>90%) with wide resection.

• Stage IIb prognosis depends on the site of the tumor (proximal tibia, femur, pelvis, etc.) size of the tumor mass (in cm.), the degree of necrosis from neoadjuvant chemotherapy (beforeoperation chemotherapy), and pathological factors like the degree of p-glycoprotein, whether your tumor is cxcr4-positive. Her2-positive as these can lead to distant metastases to the lung. Longer time to metastases, more than 12 months or 24 months and the number of metastases and resectability of them lead to the best prognosis with metastatic osteosarcoma. It is better to have fewer metastases than longer time to metastases. Those with a longer length of time(>24months) and few nodules (2 or fewer) have the best prognosis with a 2-year survival after the metastases of 50% 5-year of 40% and 10 year 20%. If metastases are both local and regional the prognosis is different unfortunately.

• Initial Presentation of stage III osteosarcoma with lung metastates depends on the resectability of the primary tumor and lung nodules, degree of necrosis of the primary tumor, and maybe the number of metastases. Overall prognosis is 30% or greater depending.

Case Examples

Case #1

Clinical Summary

This 14-year-old white male first experienced mild pain in the left knee after playing baseball, approximately two months prior to admission. The pain persisted in an intermittent fashion, and was described as being somewhat worse at night. Approximately two weeks prior to admission, the pain increased significantly and was accompanied by marked swelling and loss of considerable motion of the knee joint. These symptoms were accompanied by a history of decreased appetite, lethargy, and a 10-pound weight loss. On physical examination, the left knee was enlarged diffusely, firm, and non-tender. Following biopsy, the patient was subjected to surgical removal of the distal femur and knee with placement of a prosthetic knee joint and bone grafts.

Autopsy Findings

The distal diaphysis of the femur and adjacent soft tissues were involved in a 15 x 10 x 10-cm mass. The cut surface of the mass was fleshy white, with focal areas of hemorrhage.

Pathological Findings

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

This is a photograph of the patient prior to surgery. Note the marked swelling of the knee.

This is a radiograph showing the tumor in the distal femur.

This is another view of the tumor in the distal femur.

This is a gross photograph of the surgical specimen with tissue dissected away to demonstrate the tumor mass.

These are cut sections of the distal femur containing the tumor. The periosteal involvement is evident from this picture (arrows).

This is a low-power photomicrograph of decalcified histologic section from this tumor. Note the blue color (cell nuclei stain blue) of much of this section indicating the increased cellularity of the tumor.

This is a higher-power photomicrograph of decalcified histologic section from this tumor. There are areas of osteoid (1) and cellular areas (2).

This is a high-power photomicrograph of decalcified histologic section showing the cellularity of the tumor.

This high-power photomicrograph demonstrates the cellular growth pattern. Note that the cells are fusiform and they grow in sheets.

This high-power photomicrograph demonstrates the growth pattern and the cell morphology.

This is a high-power photomicrograph of the tumor cell morphology and the periosteum (arrow).

This high-power photomicrograph of the tumor demonstrates the fusiform morphology of the cells. Note the marked variability in size and staining intensity of the nuclei.

This is a high-power photomicrograph of the tumor demonstrating the anaplastic cell morphology.

This is a high-power photomicrograph of the tumor demonstrating the anaplastic cell morphology.

This is a high-power photomicrograph of the tumor demonstrating the anaplastic cell morphology and multiple mitotic figures (arrows).

Additional Resources

• James, H. (1979). Promises in the Dark. New York: Bantam Books. ISBN 0-553-13453-1. Story of a young girl's osteosarcoma fight and its effect on her relationship with her boyfriend
• Trottier, Maxine (2005). Terry Fox: A Story of Hope. Markham, Ont: Scholastic Canada. ISBN 0-439-94888-6. About Terry Fox and his quest to raise $25 million for cancer research by running across Canada on his prosthetic leg. Also The Terry Fox Story, a 1983 movie.
• Belshaw, Sheila M. (2001). Fly With a Miracle. Denor Press. ISBN 0 9526056 7 8.

External links

• Superior Survivial Seen with Osteosarcoma 2004
• Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment
• http://www.emedicine.com/PED/topic1684.htm
• http://www.mayoclinic.org/osteosarcoma/index.html
• Support Group and Information for people with osteosarcoma
• Treatment Information from U.S. National Cancer Institute
• Osteosarcoma by Peter Buecker, MD and Mark Gebhardt, MD
• Green Drakkoman Foundation to assist Warriors of Rare Childhood Cancers

Acknowledgements

The content on this page was first contributed by: C. Michael Gibson M.S., M.D.