OSTEOSARCOMA

BY: NURUL NADHIRAH IBRAHIM

Most common primary malignant tumor

Defined as tumor of mesenchymal cells

characterised by the formation of osteoid or
bone by the tumor cell
Age of presentation: 10-25 years old
Most common site of the bone: lower end of
femur, upper end of tibia, upper end of humerus
Highly malignant tumor arising within the bone
and rapidly spreading outwards to the
periosteum and surrounding soft tissue

Part of bone commonly involved: METAPHYSIS

PATHOLOGY
Tumour usually situated in the
METAPHYSIS of long
bone,where it destroys and
replaces normal bone.
Areas of bone loss and cavitation
alternate with dense patches of
abnormal new bone.
The tumour extends within medulla
and across epiphyseal plate.
There maybe obv spread into soft
tissue with ossification at
periosteal margin and streaks of
new bone extend into
extraosseous mass.

The dominant
features in the
histological sections
were malignant
stromal tissue
showing osteoid
formation (pink
masses)

CLINICAL FEATURES

PAIN

LUMP

First symptoms, constant, worst at night and

gradually increasing in severity
Region of metaphysis, skin over swelling is shiny
with prominent veins
Warm and tender, not well defined margin
movement of adjacent joint may be limited

Pathological fracture

May present but rare

INVESTIGATION & DIAGNOSIS

Imaging

X-rays of both local

and chest.
MRI and CT- to
evaluate the extent of
tumor

The metaphyseal site shows

increase in density, cortical
erosion and periosteal
reaction

sunburst effect

Codmans triangle

MRI (coronal,sagittal and axial)

INVESTIGATION (cont)

Serum Alkaline Phosphatase

Has no diagnostic significance

However, rise in SAP after tumor resection after its
fall may suggest recurrence

Biopsy

Should always be conducted BEFORE

commencing the treatment

Surgical stages as described by Enneking

Stage

Grade

Site

Metastases

IA

Low

IC

No

IB

Low

EC

No

IIA

High

IC

No

IIB

High

EC

No

IIIA

Low

I/EC

Yes

IIIB

High

I/EC

Yes

C.Treatment of tumour

Local control

Surgical ablation
Amputation
Recently, limb-saving
surgery
Radiotherapy

Control of metastases

Chemotherapy
Immunotherapy

TREATMENT

Aim ; 1.To confirm the diagnosis

2. To evaluate the spread of tumour
3. To give adequate treatment
A.Confirmation of the diagnosis

Histologically,tumour new bone formation is pathognomonic of an

osteosarcoma.
B.Evaluation of spread of tumour

To know the extend of involvement in affected bone & the spread of tumour
to other sites.

The lung is the earliest site for metastases. Routine CXR can be done to
detect the same.

Bone scans for intramedullary spread (skip lesion)

CT and MRI for soft tissue spread

Clinical suspicion
Local part x-ray & CXR
Biopsy to confirm the diagnosis
CXR normal
local control (A)

Limb
ablation
surgery

Limb
saving
surgery

Control of
metastases
Neo-adjuvant
Chemo
Adjuvant
chemo

Prognosis Radical resection

good,pt use with reconstruction
Arthrodesis
artificial
Joint replacement
limb

CXR shows 2

Single
on CT

Multiple

Resection of
the 2 and
treatment as
In (A)

Palliative
ablation and
chemotherapy

Prognosis fair

Prognosis poor

PROGNOSIS

W/out treatment,death occur within 2 years, usually within 6 months of

detection of metastases.
5 years survival with surgery alone is 20%
With surgery & chemotherapy, a 5 year disease free-period is 70%
A primarily lytic (telengiectatic) osteosarcoma has the worst prognosis.