Simultaneous Pulmonary and Inferior Vena Cava Thromboembolism Secondary to Pelvic Osteosarcoma

Abstract

Thromboembolism presenting with malignancy is common in adults but rare in children. We describe the case of a 17-year-old boy admitted to our hospital with syncope. Computed tomography revealed thromboembolism in both the lungs. Magnetic resonance imaging found thromboembolism in the inferior vena cava and a large heterogeneous mass in the pelvis. Pelvic osteosarcoma was confirmed by computed tomography-guided biopsy. Despite intensive chemotherapy and local radiation, only transient response was noted, the tumor remaining unresectable. To our knowledge, this is the first reported case of simultaneous pulmonary and inferior vena cava thromboembolism secondary to pelvic osteosarcoma in children. We also emphasize syncope as a unique feature of pulmonary thromboembolism. Accordingly, thromboembolism should be kept in mind as the first manifestation of occult malignancy, even in children.

Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: A mono‐institutional retrospective study of 115 cases

“…However, the differentiation between VTT and nontumor thrombus could be difficult sometimes. According to our experience and previous literatures, the thrombus that shows calcification, streak‐like enhancement, homogenously hyperintensity on T2WI, FDG uptake in PET/CT, and normal serum level of D‐dimmer is more likely to be a tumor thrombus …”

“…Moreover, we speculated that the real incidence of VTT in pelvic osteosarcoma could be higher because we only included cases undergone surgeries in this study. Those nonsurgically treated cases were generally more advanced and might have a higher chance to develop VTTs …”

“…Venous tumor thrombus (VTT) is not uncommonly seen in some retroperitoneal malignancies such as renal cell carcinoma and is occasionally noted as a rare condition in patients with osteosarcoma according to the previous literature . Almost all of the literal records about VTT in osteosarcoma were case reports with extremely poor outcomes and the pelvic ring was the most common location of those cases …”

“…Pelvic osteosarcomas accounted for only <10% of all osteosarcomas and their outcomes remained disappointing despite aggressive chemotherapy and surgery, with 5‐year overall survival (OS) ranging from 18% to 45% . The outcome would be much worse when a pelvic osteosarcoma was complicated by VTT and then a treatment dilemma would be encountered . Moreover, an unanticipated VTT found during operation would tremendously increase the risk of perioperative mortality and repudiate the significance of invasive resection of the tumor due to the compromised margin within the vessel .…”

“…Venous tumor thrombus (VTT) is not uncommonly seen in some retroperitoneal malignancies such as renal cell carcinoma 1 and is occasionally noted as a rare condition in patients with osteosarcoma according to the previous literature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Almost all of the literal records about VTT in osteosarcoma were case reports with extremely poor outcomes and the pelvic ring was the most common location of those cases. 1,4,[6][7][8][9]11,13 Pelvic osteosarcomas accounted for only <10% of all osteosarcomas and their outcomes remained disappointing despite aggressive chemotherapy and surgery, with 5-year overall survival (OS) ranging from 18% to 45%.…”