Simultaneous occurrence of osteosarcoma and osteochondroma following treatment of neuroblastoma with chemotherapy, radiotherapy, and bone marrow transplantation

Abstract

Radiation-induced bone changes and second malignancies, as well as benign tumors, following bone marrow transplantation are being reported with increasing frequency. An osteosarcoma of the fourth right rib and an osteochondroma of the left scapula developed in a long-term survivor of abdominal neuroblastoma treated with chemotherapy, local radiation, and bone marrow transplantation. All these treatment modalities are known to induce neoplasia.

Secondary osteosarcoma arising from osteochondroma following autologous stem cell transplantation with total-body irradiation for neuroblastoma: A case report

“…The study reported the case of an 11-year-old patient who presented with osteosarcoma of the fourth right rib and osteochondroma of the left scapula 9.5 years after receiving radiation, chemotherapy, TBI and BMT for abdominal neuroblastoma. However, the study did not report malignant transformation of osteochondroma (7). Additionally, one study reported the case of a 34-year-old man with chondrosarcoma arising from radiation-induced osteochondroma of the left posterior eighth rib.…”

“…The rate of malignant transformation in primary osteochondroma, principally into chondrosarcoma, is estimated to be 1-5% (6), and transformation into osteosarcoma is rare. The simultaneous occurrence of osteosarcoma and osteochondroma following treatment of neuroblastoma with chemotherapy, radiotherapy and autologous peripheral HSCT rescue has been reported previously (7). However, the current literature indicates a low incidence of malignant degeneration in radiation-induced osteochondroma (8)(9)(10) and only one case of chondrosarcoma arising within radiation-induced osteochondroma following childhood TBI has been reported thus far (11).…”

Osteochondroma after pediatric hematopoietic stem cell transplantation: report of eight cases

“…[2][3][4][5][6] To our knowledge, there have been only 21 reported observations of OS essentially found in the long bones following HSCT ( Table 2). All were in children aged less than 8 years at the time of transplantation and all had received TBI (fractionated in eight (12 Gy), single dose (7 Gy) in four, unknown fractionation in nine (9-14.4 Gy)) ( Table 2) as part of the conditioning regimen.…”

“…15,16 Moreover, the simultaneous occurrence of osteosarcoma and osteochondroma following autologous HSCT for neuroblastoma has been recently reported. 4 Even if the likelihood of malignant change is quite low, the generally increased risk of second malignancies, particularly in young children, 17 warrants continued skeletal survey of long-term survivors of childhood HSCT. Systematic biopsy or resection is not necessary and surgical treatment may be needed only when articular function or neurovascular structures are impaired.…”

“…Cataract, airway and pulmonary disease, secondary malignancies and musculo-skeletal problems are also frequent compli- cations. 1,2 Among these latter, osteochondroma have been reported only rarely, [3][4][5][6] although this condition is wellknown after local irradiation in children. [7][8][9][10] We report eight children who developed an osteochondroma following HSCT.…”