Answer for BIR CoW 24 Nov 2024
OSTEOSARCOMA
Findings
The frontal radiograph of the right shoulder shows an ill-defined permeative mixed lesion on the proximal meta-diaphysis of the right humerus with a wide zone of transition and adjacent cortical destruction. There is a sunburst periosteal reaction surrounding the lesion.
Discussion
Osteosarcoma is the second most common primary bone tumor after multiple myeloma, accounting for ~20% of all primary bone tumors.
Can be divided into primary and secondary
Primary osteosarcoma typically occurs in young patients (10-20 years) with slight male predominance
Secondary osteosarcoma occurs in the elderly, usually secondary to malignant degeneration of Paget disease, extensive bone infarcts, and post-radiotherapy for other conditions.
Typically occurs at the meta diaphysis of long bones, most commonly distal femur, proximal tibia, and humerus.
Plain radiograph
Medullary and cortical bone destruction Wide zone of transition, permeative or moth-eaten appearance Aggressive periosteal reaction - sunburst type, codman triangle and lamellated (onion skin) reaction Soft-tissue mass Tumor matrix ossification/calcification
MRI
Useful to determine accurate local staging and assessment for limb-sparing resection, particularly for evaluation of intraosseous tumor extension and soft-tissue involvement
Treatment
Aggressive surgical resection often with amputation followed by chemotherapy
Differential diagnosis
Osteomyelitis, Metastatic lesion to the bone, Ewing sarcoma, Aneurysmal bone cyst
Findings
The frontal radiograph of the right shoulder shows an ill-defined permeative mixed lesion on the proximal meta-diaphysis of the right humerus with a wide zone of transition and adjacent cortical destruction. There is a sunburst periosteal reaction surrounding the lesion.
Discussion
Osteosarcoma is the second most common primary bone tumor after multiple myeloma, accounting for ~20% of all primary bone tumors.
Can be divided into primary and secondary
Primary osteosarcoma typically occurs in young patients (10-20 years) with slight male predominance
Secondary osteosarcoma occurs in the elderly, usually secondary to malignant degeneration of Paget disease, extensive bone infarcts, and post-radiotherapy for other conditions.
Typically occurs at the meta diaphysis of long bones, most commonly distal femur, proximal tibia, and humerus.
Plain radiograph
Medullary and cortical bone destruction Wide zone of transition, permeative or moth-eaten appearance Aggressive periosteal reaction - sunburst type, codman triangle and lamellated (onion skin) reaction Soft-tissue mass Tumor matrix ossification/calcification
MRI
Useful to determine accurate local staging and assessment for limb-sparing resection, particularly for evaluation of intraosseous tumor extension and soft-tissue involvement
Treatment
Aggressive surgical resection often with amputation followed by chemotherapy
Differential diagnosis
Osteomyelitis, Metastatic lesion to the bone, Ewing sarcoma, Aneurysmal bone cyst
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!