Central nervous system metastasis from osteosarcoma: Case report and literature review

Abstract

Osteosarcoma is the most common primary malignancy of bone in children and young adults, the highest incidence peak is during adolescence and doesn't have any gender predominance. The main site of metastasis are the lungs and extrapulmonary cases are occasional. The incidence of metastasis in the Central Nervous System (CNS) is 2-6.5%, increase to 10-15% in patients with pulmonary metastases. Therefore, metastatic disease of the CNS is rare and the information on such patients is limited. Here, we describe a case of a 20-year old patient diagnosed with osteosarcoma in the left distal femur stage IIB, he developed pulmonary disease, during palliative chemotherapy experienced relapse to the brain classified as (RPA) class II, and was treated with external radiotherapy (30 Gy in 10 fractions) and later he had a poor evolution and died.

Isolated Cerebral Metachronous Metastasis in Fibular Osteosarcoma: A Rare Case Report with Review of Literature

“…24 Similar case reports were observed where fibroblastic osteosarcoma presented with brain metastasis after 15 months of pneumonectomy for lung metastasis 25 and pulmonary, isolated central nervous system relapse can occur in patients with fibroblastic osteosarcoma. 26,27 Osteosarcoma can present with hemorrhagic cerebellar metastasis, where the patient presented with acute neurologic deterioration 28 and multifocal osteosarcomas of the skull presenting with intracranial hemorrhage. 29 Isolated cerebral metastasis was also observed in a few cases, and most of the patients presented with raised intracranial hypertension.…”

Genome-Driven Therapy for Chemotherapy-Resistant MetastaticCDK6-Amplified Osteosarcoma

“…Brain metastasis is exceedingly rare at diagnosis and confers a substantially worse prognosis. 25 Furthermore, the patient experienced rapid progression and significant toxicity on standard osteosarcoma chemotherapy, making it unlikely that common second-line cytotoxic regimens would have been durably effective or tolerable.…”

The dynamic microenvironment associated with metastatic bone disease: Current concepts

“…This results in activated osteoblasts to release RANKL and IL-6 which affect bone processes such as inflammation, cell trafficking, and bone resorption, which are important for the development of MBD. [106][107][108] Treatments for bone pain include denosumab and bisphosphonates which have been shown to reduce bone pain in part through the reduction in osteoclast activity. Similarly, anti-cathepsin K treatment can reduce bone pain.…”

“…Severe emotional stress from the experience of pain increases SNS activity, which causes the release of adrenergic compounds like norepinephrine and epinephrine. This results in activated osteoblasts to release RANKL and IL‐6 which affect bone processes such as inflammation, cell trafficking, and bone resorption, which are important for the development of MBD 106–108 . Treatments for bone pain include denosumab and bisphosphonates which have been shown to reduce bone pain in part through the reduction in osteoclast activity.…”