Periosteal osteosarcoma - personal experience with five cases
Authors:
Zdeněk Kinkor 1; Henrieta Šidlová 2; Iveta Mečiarová 3; Andrej Švec 4; Marián Švajdler ml. 1; Peter Vasovčák 5; Roman Kodet 6; Zdeněk Matějovský 7; Ľubomír Straka 8
Authors‘ workplace:
Bioptická laboratoř s. r. o., Šiklův ústav patologie, LF UK, Plzeň
1; Cytopathos s. r. o., Bratislava
2; Alfa Medical Patológia, FN Ružinov, Bratislava
3; Ortopedická klinika, Univerzitná nemocnica Akademika Dérera, Bratislava
4; Gendiagnostika s. r. o., Košice
5; Ústav patologie a molekulární medicíny, 2. LF UK, FN Motol, Praha
6; Ortopedická klinika, Nemocnice na Bulovce, Praha
7; Ústav patologie, FN Prešov
8
Published in:
Čes.-slov. Patol., 51, 2015, No. 4, p. 193-198
Category:
Original Articles
Overview
The authors present five cases of periosteal osteosarcoma located in the femur (4) and tibia (1) in children and young adults (1 female and 4 males) with an age range of 9 - 23 years (mean age 15 years). Radiographs in all cases showed a broad-based soft tissue mass attached to the cortex with periosteal reaction and in two of them cortical disruption with extensive medullary involvement. Follow-ups were available in four cases (range 11 - 73 months) and revealed pelvic metastasis after 15 months with ultimately rapid dissemination and death in a 9-year-old girl and metastasis to the humerus after 13 months in a 15-year-old boy. The former tumor widely extended into the medullary cavity and an amputation was carried out, the latter had a pure juxtacortical position and an en block resection was performed; both of them were treated with chemotherapy. All the lesions displayed distinctive structural patterns combining a large island of tumorous cartilage and hypocellular, bland-looking myxoid mesenchymal stroma with abrupt transition between both components. Contrary to conventional osteosarcoma, the delicate flocculent osteoid deposits were produced by innocuous stromal cells lacking apparent atypia. They were strictly situated outside the prevailing chondroid areas and disclosed sometimes only after a meticulous search. Immunohistochemical detection of SATB2, S100protein and D2-40 assisted effectively not only in recognition of the real stromal histogenetic derivation, but also in distinction of true differentiation of a heavily mineralized extracellular matrix. Molecular analysis revealed no IDH1/2 mutation in four examined cases. Regardless of unique low-grade morphology in rare periosteal osteosarcoma, an aggressive therapeutical approach similar to conventional osteosarcoma is justified, particularly in the case of a medullary extension.
Keywords:
bone - periosteal osteosarcoma - chondroplastic osteosarcoma - SATB2 - isocitrate dehydrogenase
Sources
1. Cesari M, Alberghini M, Vanel D, Palmerini E, et al. Periosteal osteosarcoma: a single institution experience Cancer 2011; 117: 1731-1735.
2. Damato S, Alorjani M, Bonar F, McCarthy SW, et al. IDH1 mutations are not found in cartilaginous tumors other than central and periosteal chondrosarcomas and enchondromas. Histopathol 2012; 60: 363-365.
3. Delling G, Amling M, Posl M, Ritzel H, et al. Periosteal osteosarcoma. Histologic characteristics, preparation technique, growth pattern and differential diagnosis. Pathologe 1966; 17: 86-91.
4. Grimer RJ, Bielack S, Flege S, Cannon SR, Foleras G. Periosteal osteosarcoma: a European review of outcome. Eur J Cancer 2005; 41: 2806-2811.
5. Gulia A, Puri A, Pruthi M Desai S, et al. Oncological and functional outcome of periosteal osteosarcoma. Indian J Orthop 2014; 48: 279-284.
6. Kato K, Liu X, Oki H, Ogasavara S, et al. Isocitrate dehydrogenase mutation is frequently observed in giant cell tumor of bone. Cancer Sci 2014; 105: 744-748.
7. Kerr DA, Lopez HU, Deshpande V, Hornicek FJ, et al. Distinction of chondrosarcoma from chondroblastic osteosarcoma trough IDH1/2 mutations. Am J Surg Pathol 2013; 37: 787-795.
8. Liu X, Kato Y, Kaneko MK, Sugawara M. Isocitrate degydrogenase 2 mutation is a frequent event in osteosarcoma detected by a multi-specific monoclonal antibody MsMab-1. Cancer Med 2013; 2: 803-814.
9. Murphey MD, Jelinek JS, Temple HT, Flemming DJ, Gannon FH. Imaging of periosteal osteosarcoma: radiologic-pathologic comparison. Radiology 2004; 233: 129-138.
10. Revell MP, Deshmukh N, Grimer RJ, Carter SR et al. Periosteal osteosarcoma: a review of 17 cases with mean follow-up of 52 months. Sarcoma 2002; 6: 123-130.
11. Rose PS, Diskey ID, Wenger DE, Unni KK, Sim FH. Periosteal osteosarcoma: long-term outcome and risk of late recurrence. Clin Orthop Relat Res 2006; 453: 314-317.
12. Suehara Y, Yazawa Y, Hitachi K, Yazawa M et al. Periosteal osteosarcoma with secondary bone marrow involvement: a case report. J Orthop Sci 2004; 9: 6
Labels
Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
2015 Issue 4
Most read in this issue
- Periosteal osteosarcoma - personal experience with five cases
- Transplantations of lungs in the Czech Republic – from the perspective of the pathologist
- Diagnosis of rejection in a transplanted liver
- Surgical techniques of organ transplants