Periosteal osteosarcoma

Abstract

An analysis of 6 patients with periosteal osteosarcoma treated by the authors along with a review of 55 patients reported in the literature demonstrates that periosteal osteosarcoma is distinctly different from conventional osteosarcoma or periosteal chondrosarcoma. Periosteal osteosarcoma is a less aggressive tumor than conventional osteosarcoma. It is a relatively well‐differentiated chondroblastic osteosarcoma occurring on the surface of the long bones of the extremities. Three patients demonstrated frank medullary invasion of tumor, two grossly and one microsurgically. Patients treated with marginal resection had a 70% local recurrence rate. Patients receiving wide resection or primary amputation have survived longer with less recurrence of disease. Overall, 10 of 61 patients are dead with metastatic disease with a mean reported follow‐up of 6 years and 7 months. Adjunctive therapy has been of no demonstrable aid in terms of prolonging survival. Medullary extension of this tumor should not be used to exclude this diagnosis. The authors believe that the treatment of choice is wide resection without adjunctive chemotherapy.

Periosteal Osteosarcoma Arising from the Rib and Scapula: Imaging Features in Two Cases

“…Also, cortical bone adjacent to PEROSA usually appears to be thickened and scalloped, in which the bone permeation or destruction is not a common finding of PEROSA (7). In the study of Hall et al (1) with 61 cases of PEROSA, the gross medullary extension was observed in 2 cases, microscopic medullary extension in 1 case, and cortical bone permeation in another case. Murphey et al (7) also reported 1 case of medullary invasion, accounting for 2% of their series.…”

“…To our knowledge, PEROSA is extremely rare in flat bones (1). In the study of Burt et al (4) with 38 cases of chest wall osteosarcoma, 13 cases (34%) including the post-radiation osteosarcoma arose in the rib and 12 cases (32%) arose in the scapula, but no PEROSA was found.…”

“…Moreover, Sonobe et al (9) and Suehara et al (10) each reported 1 case of PEROSA with medullary invasion. Therefore, with the unusual and distinctive radiologic and histologic findings of PEROSA, the medullary involvement or cortical bone permeation should not be precluded as the diagnosis (1, 7). In our case of the rib, the medullary cavity did not seemed to be involved according to the pre-operative imaging studies including the CT, but the intramedullary involvement was found on the specimen CT and was pathologically proved.…”

“…Therefore, currently recommended treatment for PEROSA consists of wide segmental resection, with or without neoadjuvant chemotherapy (5). The metastatic potential of PEROSA is much lower than that of conventional osteosarcoma, with a rate of distant metastasis of 10-20%, and mostly common to the lung (1). The prognosis of PEROSA is better than that of the conventional intramedullary osteosarcoma and high-grade surface osteosarcoma, but it is worse than that of parosteal osteosarcoma (5).…”

“…Periosteal osteosarcoma (PEROSA) is an intermediate-grade malignancy arising on the surface of bones, frequently in femur and tibia, followed by ulna and humerus in extremities (1, 2). PEROSA of the chest wall, unlike that of the extremities, presents a diagnostic challenge because of the extreme rarity of the lesion, variable clinical symptoms, and suboptimal visualization on radiography of the characteristic features, resulting in misinterpretation of the lesion as a variety of other diseases (3).…”