Osteosarcoma

Osteosarcoma
Updated: 09/24/2018
© Jun Wang, MD, PhD

General features
  • Any malignant tumors that produce osteoid directly from tumor cells
  • Most common primary bone tumor after myeloma
  • Young age, 10-25
  • Most common metastasis site: Lung
  • Rare metastasis to lymph nodes
Risk factors
If > 40
  • Paget disease
  • Radiation exposure
  • Thorotrast
  • Childhood chemotherapy
  • Other bone disorders such as fibrous dysplasia, osteochondromatosis, chondromatosis, etc
Clinical presentations
  • Most common clinical presentation: Localized pain
  • Mass
Most common site
  • Metaphysis of long bones, especially around the knee
  • Medullary cavity
Key pathogenesis
  • Unclear, probably associated with rapid bone growth
Key laboratory findings
  • Elevated alkaline phosphatase
Key radiological findings
  • Large, destructive mass
  • Lytic or blastic
  • Permeative margins
  • Sunburst pattern due to bone formation
  • Codman’s triangle: Shadow between cortex and raised ends of periosteum (due to reactive bone formation), non-specific (can be seen in Ewing sarcoma)
Key morphological features
  • Most commonly metaphysis
  • Bulky invasive mass with hemorrhage and necrosis
  • Pleomorphic tumor cells with osteoid matrix
Genetic abnormalities
  • Combined p53 and Rb mutation common
  • P53 mutations if multicentric


Negative prognosis indicator
  • Paget disease
  • Telangiectatic histology
  • Elevated serum alkaline phosphatase
  • Minimal postchemotherapy tumor necrosis
  • Involvement of craniofacial bones (not jaw) or vertebrae
  • Multifocal tumor
  • Loss of heterozygosity of RB gene
Treatment
  • Surgery
  • Chemotherapy


Back to bone tumors
Back to contents

Comments

Post a Comment

Popular posts from this blog

Contents

Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders 4.  Benign blood cell disorders Anemia Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Adrenal gland Thyroid gland Parathyroid gland Endocrine pancreas M
Read more

Anemia

Anemia Updated: 07/13/2024 © Jun Wang, MD, PhD   General features Decrease in red cell mass Hemoglobin: Levels of hemoglobin in a specific volume of whole blood Hematocrit: Fraction of whole blood composed of red blood cells Red cell count: Quantity of red cell in a specific volume of whole blood Three major groups based on RBC sizes Microcytic Normocytic Macrocytic Three major causes Blood loss: acute or chronic Increased red cell destruction: hemolysis Reduced production: marrow failure due to genetic abnormality or nutritional deficiency Etiology Genetic abnormality Hemoglobinopathies RBC cytoskeletal abomorlities Enzyme abnormalities Fanconi anemia Nutritional deficiencies: iron, VB12, folate, general malnutrition Physical etiologies: trauma, burns, frostbite, prosthetic valves, etc Chronic diseases: chronic infections, neoplasia, autoimmune disorders, kidney or liver diseases, etc Infectious diseases: hepatitis, sepsis , malaria, etc
Read more

Lymphoid neoplasms

Lymphocytic neoplasms Updated: 05/17/2020 © Jun Wang, MD, PhD Terminology Lymphoma : Proliferations forming discrete tissue masses Leukemia : Widespread involvement of the bone marrow and usually the peripheral blood Any "lymphoma" can present with or evolve to a leukemic picture, and any "leukemia" can occasionally present with a mass lesion Other hematology terms Important risk factors Immunodeficiency (primary or secondary) Autoimmune disorders Viruses (HIV, KSHV/HHV8, HTLV-1) H. pylori infection Radiation Chemotherapy Diagnostic approaches Complete history, especially those with possible epidemic characters, such as Burkitt lymphoma CBC, Bone marrow Morphology/immunohistochemistry Immunofluorescence flow cytometry Cytogenetic studies Molecular studies Commonly used markers All lymphomas: CD45 B-cell neoplasms: CD5, CD10, CD19, CD20, CD79a, CD23, bcl2, bcl6, cyclin D1, light chai
Read more