Osteosarcoma DR: Gehan mohamed 1

10/5/20152 Osteosarcoma

3 Definition Osteosarcoma is an aggressive malignant neoplasm arising from primitive transformed cells of mesenchymal origin (and thus a sarcoma) that exhibit osteoblastic differentiation and produce malignant osteoid.malignant neoplasmmesenchymal sarcomaosteoblasticmalignantosteoid It is the most common histological form of primary bone cancer in age 12-25yrs.histologicalbonecancer

4 Epidemiology Male more than female at any age but 75% of cases appear at age 12-25yrs

5 Risk factors: Radiation exposure Patients who survive after taking therapy for another Cancer. Retinoblastoma(malignant tumor arising from retina of eye).

Sites of predlection: Osteosarcoma :It originates more frequently in the metaphyseal region of tubular long bones, with 42% occurring in the femurmetaphyseal bones 6

Skeletal distribution : most common at Knee region 7

osteosarcoma 8

Histopathologic variants 1. Conventional: osteoblastic, chondroblastic, fibroblastic 2. Multifocal 3. Telangiectatic 4. Small cell 5. Intraosseous well-differentiated 6. Intracortical 7. Periosteal 8. Paraosteal 9. High-grade surface 10. Extraosseous 9

Diagnosis of osteosarcoma Clinical examiation Radiologic examinatiom Biopsy for histopathology 10

11 Clinical Presentation Painful mass arising from bone Metastasize early

12 Plain Xray The area of tumor mass may be Lytic, sclerotic or mixed

In x – ray we can see Codman triangle Codman triangle is a term used to describe the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone.subperiostealperiosteum sun-burst" appearance on X-ray examination due to the tumor spicules of calcified bone radiating in right angles 13

Codman triangle 14

Codman triangle 15

16 Local CT MRI +/- Angiogram

17 Systemic Bone scan CT Chest

Osteosarcoma : it is formed of Spindle shaped cells showing malignant criteria in form of pleomorphism,hyperchromasia, abnormal mitosis, giant cells. In between spindle cells there is malignant osteoid. 18

19 Differential Dx Giant Cell Tumor Aneursymal Bone Cyst Ewings tumor Osteoblastoma Metastasis Lymphoma