We describe a case of chondroblastic osteosarcoma of the vertebral column in a 67-yr-old male in whom the preoperative diagnosis was made by fine-needle aspiration biopsy (FNAB).Key Words: osteosarcoma; vertebral column; fine-needle aspiration biopsy; complications; cytology Although osteosarcoma represents the most common primary sarcoma of bone, it occurs only rarely in the vertebral column. 1,2 This location accounts for 1-3% of biopsyproven osteosarcomas and half of these cases develop secondary to radiation therapy, Paget's disease, or malignant transformation of a benign neoplasm such as osteoblastoma. [3][4][5] The diagnosis and treatment of vertebral osteosarcoma often present a serious challenge, and the management of this neoplasm has evolved considerably over the past few decades. 6 This case report describes a patient with primary osteosarcoma of the eighth thoracic vertebra diagnosed preoperatively by fine-needle aspiration biopsy (FNAB). This procedure was complicated by Corynebacterium infection. We review the literature on the subject of osteosarcoma of the vertebral column, present the features that distinguish this lesion from osteoblastoma, and discuss the diagnosis of bone tumors by FNAB, a diagnostic modality that figures prominently in the evaluation of lesions of the vertebral column. Case ReportThis 67-yr-old male with coronary artery disease presented with unremitting interscapular pain. Although he denied any recent injury, he had fallen from his roof approximately 18 mo prior to the onset of his back pain. In retrospect, it does not appear that he sustained a significant injury in this fall since a routine chest X-ray performed 6 mo later failed to reveal any pathology in the thoracic vertebral column. Over the course of 1 mo, his back pain increased in intensity, leading to radiological investigation. A plain X-ray of the thoracolumbar vertebral column revealed a fracture of the T8 end plate with sparing of the pedicles. A technetium pyrophosphate bone scan showed intense uptake of the radioisotope in the T8 vertebral body with no other focal lesions. A chest X-ray and abdominal ultrasound failed to reveal any suspicious lesions and laboratory investigations, which included a serum prostate specific antigen (PSA) and serum protein electrophoresis, were within normal limits. The patient was managed with nonsteroidal anti-inflammatory agents and narcotic analgesics which temporarily alleviated his back pain. Upon returning from a summer
We describe a case of chondroblastic osteosarcoma of the vertebral column in a 67‐yr‐old male in whom the preoperative diagnosis was made by fine‐needle aspiration biopsy (FNAB). This diagnosis was subsequently confirmed in the T8 corpectomy specimen. Although the smears of the aspirate revealed only occasional markedly atypical spindle‐shaped nuclei, the cell block was diagnostic of malignancy. It showed a well‐preserved fragment of neoplastic cartilage populated by markedly atypical hyperchromatic cells and a crushed fragment of anaplastic spindle‐shaped cells surrounded by opaque collagenous matrix reminiscent of osteoid. The surgically resected specimen exhibited comparable histological features as well as colonies of gram‐positive bacilli within the necrotic tumor. Culture confirmed the presence of Corynebacterium species. It is likely that these skin organisms were introduced at the time of FNAB. This case demonstrates the value of FNAB in the diagnosis of primary bone tumors and reports a rare complication of this procedure. Diagn. Cytopathol. 1999;20:38–43. © 1999 Wiley‐Liss, Inc.
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