OSTEOSARCOMA Must Knows

INTRODUCTION
• Sarcomas : arise from cells of the embryonic mesoderm.
• majority of sarcomas are soft tissue sarcomas
• other types: bone sarcomas
– (osteosarcoma,chondrosarcoma, and rare bone tumors like chordoma,
angiosarcoma, and leiomyosarcoma of bone) and Ewing’s sarcoma/ peripheral
primitive neuroectodermal tumor, which can occur either in the bone or in the
soft tissues.
• extremity (50–60%); trunk (19%), retroperitoneum (15%), and head and
neck (9%).
• anatomic site of a primary sarcoma influences treatment and outcome.
 ETIOLOGY
• Radiation Exposure
• Occupational Chemical Exposure
• Trauma
• Chronic Lymphedema (for lymphangiosarcoma)
ETIOLOGY genetic
 OSTEOSARCOMA

The most common primary malignant bone.

• Osteosarcomas are classified as osteoblastic,chondroblastic,
fibroblastic, telangiectatic, round cell, orMFH-like, according to the
predominant cell type.
 between 10 and 20 years of age.
 Secondary osteosarcomas:
• occur in older patients in abnormal bone affected by Paget’s disease,
radiation, or bone infarct.
 Intramedullary Osteosarcoma
• most common primary sarcoma of the bone.
• distal femur or the proximal tibia in young
• may also occur at the proximal humerus, proximal femur, or pelvis
• Highgrade extracompartmental disease
• metastasize to the bone“skip lesion,”
• lung is the primarysite of metastases.
• Long term survival is 75% with adequate treatment. The response
to chemotherapy
 Intramedullary Osteosarcoma
• Present with pain and swelling,
• “Codman’s Triangle.”
• X-rays may show bone formation with a sunburst appearance.
• MRI should involve the entire bone to diagnose the skip metastasis.
• CT scans of the chest are usually done to find primary metastases.
• Alkaline phosphatase is usually high
• Diagnosis:biopsy.
biopsy should be done by the same surgeon who will provide the definitive treatment
for the patient
• Treatment of osteosarcoma will be preoperative chemotherapy and wide resection,
followed by postoperative chemotherapy.
 Parosteal Osteosarcoma
• Periosteal osteosarcoma is a high-grade tumor.
• occurs on the anterior surface of the distal femur or proximal
tibia.
• chondroblastic on histology.
• Radiographs scalloping of the underlying cortex with a
“sunburst” periostealreaction.
• Treatment is chemotherapy and wide surgical excision.
• The 5-year survival rate is 80%.
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