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OSTEOSARCOMA

A spindle cell neoplasm that produces osteoid


(unmineralized bone) or bone

Epidemiology:
Most common primary malignant bone tumor
in children & adolescents (2nd decade of life)60%
Male to female ratio (1.5-2:1)
10% occurs in the 3rd decade of life
5th or 6th decade of life is frequently secondary
to either radiation therapy

Diagnostics:
Plain radiography
- Osteosarcoma lesions can be purely
osteolytic (~30% of cases), purely
osteoblastic (~45% of cases), or a
mixture of both
- Classic radiographic appearance of
osteosarcoma is the sunburst pattern

Etiology:
DNA mutation cause by carcinogens
Hereditary
Pathophysiology:
- Trauma
- Irradiation
- Pagets disease of the bone
- Fibrous dysplasia
- Osteochondroma
high grade
(conventional)
osteosarcoma

arise in
diaphyseal
region of the
bones

Clinical Manifestation:
- Chronic
- Right thigh/ knee pain
- Limited motion
- Swelling and tenderness
- Joint effusion
- Generalized weakness
- Inability to ambulate
- Weight loss
- Easy fatigability
- Aggravated by activity
- No relief after intake of NSAID

invade
medullary
cavity

2 variants must be distinguished from conventional


1. Parosteal osteosarcoma
- Low grade
- Well differentiated tumor
- Most commonly found in posterior
aspect of femur
- Does not invade medullary cavity
2. Periosteal osteosarcoma
- Arise in the surface of bone
- Higher rate of metastatic spread than
parosteal

MRI
-

best method of assessing the extent of


intramedullary disease, as well as
associated soft-tissue masses and skip
lesions

Computed tomography
- CT of the primary lesion helps delineate
the location and extent of the tumor
and is critical for surgical planning
- CT of the chest is more sensitive than
plain film radiography is for assessing
pulmonary metastases

Ultrasonography
- not routinely used in the staging of
classic osteosarcoma lesions. The
modality may be useful in guiding
percutaneous biopsy.

Treatment
CHEMOTHERAPY
- NEO-ADJUVANT CHEMOTHERAPY: CT
ADMINISTERED BEFORE THE SURGICAL
RESECTION OF PRIMARY TUMOUR
- ADJUVANT CHEMOTHERAPY: CT
ADMINISTERED POSTOPERATIVELY TO
TREAT PRESUMED MICRO-METASTASIS
SURGERY - THE MAINSTAY OF THERAPY
- LIMB SACRIFICING SURGERY
- LIMB SALVAGING SURGERY
RADIOTHERAPY
- EXTERNAL BEAM RADIATION BY LINEAR
ACCELERETER.
- BRACHYTHERAPY LIMITED ROLE
- IORT SINGLE DOSE, IN SPECIALLY
PREPARED OT

ACUTE CRUCIATE LIGAMENT TEAR

runs diagonally in the middle of the knee.


It prevents the tibia from sliding out in front of
the femur
Provides rational stability to the knee & control
the back and forth motion of the knee

Epidemiology:
Most commonly injured knee ligament
78% of sports-related injuries
Female athletes

Histologic examination of the tumor


- Two elements are important to the
histologic examination of the tumor:
first, tumor type, can be assessed on
the biopsy; second, response to
treatment, can be assessed on the
definitive resection following
chemotherapy

Etiology:
High risk sports (changing direction rapidly,
stopping suddenly, slowing down while running,
landing from a jump incorrectly
Direct contact (tackle/ trauma)
Pathophysiology:
trauma,
overextended
knee joint,
sports

bones of the
legs twist in
opposite
directions

leading to ACL
tear

Clinical Manifestation:
- Limited motion
- Swelling and tenderness
- Joint effusion
- Inability to ambulate
- Aggravated by activity
- Alleviated by rest
- No relief after intake of NSAID
Diagnostics:
Lachman Test
- Most sensitive test for acute ACL rupture
- Performed with the knee in 30 of flexion,
with the patient lying supine
- Amount of displacement (mm) and the
quality of endpoint are assessed (firm,
marginal, soft)
- Abnormal: >3mm
- ACL tear: Asymmetry in side to side laxity
or soft endpoint

Pivot Shift Test


- Performed with the leg extended and the
foot in internal rotation, and a valgus stress
is applied to the tibia

Anterior Drawer Test


- Performed with the t 90 flexion, with the
patient lying supine
- There is an attempt to displace tibia
forward from the femur
- ACL tear: >6mm of tibial displacement
: positive only in 77% of patients with
complete ACL rupture

MRI
- Sensitivity of 90-98%
- May identify bone bruising which is present
in 90% of ACL injuries
- Should not be used as a substitute for a
good history and physical examination

treatment
Non-operative
o May be considered in elderly patients
or in less active athletes who may not
be participating in any pivoting type of
sports (running, cycling)
Arthroscopy
o Considered for persons who are poor
candidates for reconstruction but have
a mechanical block to range of motion
o
Medications
o Analgesics
NSAIDs
COX-2 inhibitors