Answer for BIR CoW 17 Sep 2023
Osteosarcoma of Left Proximal Humerus
Findings:
- Expansile mixed lytic and sclerotic lesion in the meta-epiphyseal region of the left proximal humerus.
- Ill-defined lesion with a wide zone of transition.
- Presence of osteoid matrix in the lesion.
- Indicators of aggressiveness: Sunburst type of periosteal reaction and Codman’s triangle.
Discussion:
About Osteosarcoma:
- Osteosarcoma originates from mesenchymal cells and stands as the predominant primary bone malignancy in children.
- Peak incidence is during the 2nd decade of life, aligning with rapid skeletal growth.
- **Commonly Affected Areas:** Mainly the metaphysis of long bones such as distal femur, proximal tibia, and proximal humerus.
Radiographic Features Include:
- Focal lesion in the metaphysis which may appear as a mottled permeative lesion with a vague transition zone, or as a dense sclerotic region occupying the medullary space.
- Evidence of cortical disruption.
- Distinct periosteal reactions: Sunburst Periosteal reaction and Codman’s reactive triangles.
- Possibility of pathological fractures and presence of the cumulus cloud appearance in sclerotic lesions.
- Commonality of soft tissue mass, which might grow significantly, occasionally with ossifications.
Advanced Imaging Insights:
- CT Scans: Primarily for staging, biopsy assistance, and detecting lytic lesions with minimal mineralized content.
- MRI: Valuable for local staging, assessing intraosseous tumor spread, soft tissue engagement, and growth plate evaluation. In MRIs, various components exhibit different signal intensities.
- Bone Scintigraphy: Demonstrates increased activity at the primary tumor site and potential metastasis areas.
- FDG PET: Useful in detecting bone metastasis (noted by increased SUV values) and in monitoring chemotherapy responses.
Findings:
- Expansile mixed lytic and sclerotic lesion in the meta-epiphyseal region of the left proximal humerus.
- Ill-defined lesion with a wide zone of transition.
- Presence of osteoid matrix in the lesion.
- Indicators of aggressiveness: Sunburst type of periosteal reaction and Codman’s triangle.
Discussion:
About Osteosarcoma:
- Osteosarcoma originates from mesenchymal cells and stands as the predominant primary bone malignancy in children.
- Peak incidence is during the 2nd decade of life, aligning with rapid skeletal growth.
- **Commonly Affected Areas:** Mainly the metaphysis of long bones such as distal femur, proximal tibia, and proximal humerus.
Radiographic Features Include:
- Focal lesion in the metaphysis which may appear as a mottled permeative lesion with a vague transition zone, or as a dense sclerotic region occupying the medullary space.
- Evidence of cortical disruption.
- Distinct periosteal reactions: Sunburst Periosteal reaction and Codman’s reactive triangles.
- Possibility of pathological fractures and presence of the cumulus cloud appearance in sclerotic lesions.
- Commonality of soft tissue mass, which might grow significantly, occasionally with ossifications.
Advanced Imaging Insights:
- CT Scans: Primarily for staging, biopsy assistance, and detecting lytic lesions with minimal mineralized content.
- MRI: Valuable for local staging, assessing intraosseous tumor spread, soft tissue engagement, and growth plate evaluation. In MRIs, various components exhibit different signal intensities.
- Bone Scintigraphy: Demonstrates increased activity at the primary tumor site and potential metastasis areas.
- FDG PET: Useful in detecting bone metastasis (noted by increased SUV values) and in monitoring chemotherapy responses.
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!