Osteosarcoma

Osteosarcoma
Extremely malignant
Arises from primitive cells in metaphyseal
region of long bone in young individual
Osteogenic sarcoma, genesis from osteoblastic
series of primitive mesenchymal cells

Epidemiology
Second most common malignant neoplasm after
myeloma
Occurs in children, adolescents, and young adults
Most common sites are those with the most
active epiphyseal plate, which are lower end of
femur, upper end of tibia, upper hand of
humerus, pelvis
In older person it develops as complication of
paget disease, which the prognosis is extremely
grave
Pathogenesis
Osteosarcoma grows rapidly and very destructive
locally
Produces neoplastic bone, osteosclerotic
Neoplasm soon erodes the cortex of the
metaphyseal region, predisposing pathological
fracture
Grows beyond confined bone, and lifted
periosteum which produce Codmans Triangle, a
radiographic feature that showed reactive bone
form in the angle between elevated periosteum
and bone
Pathogenesis
Sunburst appearance, seen in 50% of cases, a
radiographic feature that showed the reactive
bones and neoplastic bones deposited along
blood vessels that radiate through neoplasm
from cortex to elevated periosteum

Symptoms
Pain, mild intermitten to severe constant
Joint function distubance, the neoplasm
nearly always arises in the metaphyseal region
that may interfere the joint
Develops rapidly and tender
Very vascular and overlying skin is warm
Superficial veins becomes dilated and visible
through infrared light
Radiographic
Codmans triangle
Sunburst apperance
MRI to determine intraosseus or extraosseus
extent sarcoma
Scintigraph for detecting skip lession
CT scans for Pulmonary metastases
MRI, Scintigraph, CT are required for staging
Serum Alkaline Phosphatase is usually elevated
Osteosarcoma

Codmans Triangle

Sunburst Appearance

Makroskopis

PA Slides

The malignant bone is more basophilic and has more
irregular borders than the preexisting bone trabeculae
Periosteal Osteosarcoma

Treatment
Combination of Neoadjuvant (Preoperative) and
adjuvant (Postoperative) chemotherapy,
increases 5 years survival rate to more than 70%
Chemotherapy agents include high-dose
maethotrexate, adriamycin, doxorubicin,
cycplatin, ifhophamide
Limb sparing more frequent than amputation,
but it has a complication that considerably high
Prognosis
Extremely grave, 90% of patients succumbed
pulmonary metastases within 3 years via
bloodstream
Research found that the absence of tumor
suppressive agent leads to development of
retinoblastoma as well as osteosarcoma