Synchronous multifocal osteogenic sarcoma on multimodality imaging including bone scintigraphy

Gupta, Madan M.; Bahri, Nandini; Parekh, Hiral P.; Watal, Pankaj; Chudasama, S.L.

doi:10.4103/0972-3919.136591

Cited by 8 publications

(7 citation statements)

References 8 publications

(11 reference statements)

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“…Synchronous multifocal osteosarcoma is characterised by tumorous lesions in multiple osseous sites in the absence of pulmonary metastases 1. In our case, this diagnosis is unlikely since the patient is a middle-aged male and the radiographs have central lesions which do not reveal the classical periosteal reaction with formation of the Codman’s triangle nor any ‘sunburst’ appearance.…”

Section: Descriptionmentioning

confidence: 71%

Multiple myeloma mimicking primary bone tumour

Das

Yanamandra²,

Iqbal

et al. 2019

BMJ Case Rep

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Section: Descriptionmentioning

confidence: 71%

Multiple myeloma mimicking primary bone tumour

Das

Yanamandra²,

Iqbal

et al. 2019

BMJ Case Rep

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“…However, in our case, no symptoms at the left occipital region or the right proximal humerus were observed, and it was not until a bone scan was performed that multicentric bone lesions were noted. A bone scan can assess the accumulation of tracers, thereby reflecting remodeling of the affected bone, and a systemic bone scan is useful as a regular examination for the early detection of other bone lesions [ 18 ], even if no symptoms are observed. Metachronous type multicentric osteosarcoma, or bone metastases of SMOS during the treatment course, might be due to tiny lesions with symptoms mild enough to be overlooked at the first visit.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction using a frozen autograft for a skull and humeral lesion of synchronous multicentric osteosarcoma after undergoing successful neoadjuvant chemotherapy: a case report and review of the literature

et al. 2021

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Background Synchronous multicentric osteosarcoma (SMOS) is a rare disease characterized by simultaneous multicentricity of intraosseous osteosarcoma without visceral involvement. SMOS, including a skull lesion, which occurs relatively rarely, and reconstruction using a frozen autograft after the excision of a lesion of SMOS has been infrequently reported previously. Case presentation We report an 18-year-old girl with SMOS, with lesions located in the left distal femur, right proximal humerus, and left occipital bone. Her major complaint was pain and swelling around the left knee joint. Asymptomatic lesions of the humerus and skull bone were detected on a systemic bone scan. No visceral organ metastasis was observed. A biopsy of the distal femoral lesion revealed osteosarcoma. Based on the histological findings, multiple bone lesions, and absence of visceral lesion, the clinical diagnosis of SMOS was made. After five courses of neoadjuvant chemotherapy with a regimen of doxorubicin and cisplatin, reconstruction using a tumor prosthesis following wide excision of the left distal femur was performed, and total necrosis was histologically observed in the retracted specimen. Following three cycles of adjuvant chemotherapy, tumor excision and reconstruction with a frozen autograft treated with liquid nitrogen was conducted for both lesions of the humerus and skull, rather than tumor prosthesis or synthetics, in order to retain a normal shoulder function, and to obtain a good cosmetic and functional outcome after treatment of the skull lesion. Further adjuvant chemotherapy could not be administered after the completion of the surgical treatment for all lesions because the adverse events due to chemotherapy were observed. At over 5 years after the diagnosis, she remains clinically disease-free. Conclusions An early correct diagnosis, the proper management of chemotherapy, and surgical treatment for all lesions are essential for achieving a good clinical outcome, even in SMOS including a skull lesion. By performing reconstruction using a frozen autograft for a proximal humeral lesion and a skull lesion after confirming the good histological efficacy of neoadjuvant chemotherapy for the primary lesion, the excellent function of the shoulder joint and a good cosmetic outcome at the site of the skull lesion was acquired without complications or recurrence.

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“…The smaller lesions, instead, mimic skeletal metastases on X-ray and MRI, presented as purely sclerotic or heavily mineralized metaphyseal lesion, with narrow transition zone, no cortical destruction or soft tissue mass, nor malignant periosteal reaction, in contrast to the metachronous group, which most of the lesions appeared similar to the presentation of primary osteosarcoma. 9–11 …”

Section: Discussionmentioning

confidence: 99%

Advance MR evaluation of synchronous multifocal osteosarcoma with pathologic fracture

Setiawati

Lay

Testini³

et al. 2021

BJR|case reports

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Objective: Synchronous multifocal osteosarcoma is a rare condition in which the osteosarcoma presents with multiple bone lesions at the time of diagnosis, usually without any visceral metastases. The first case was described in early 1930s by Silverman. To report a case of synchronous multifocal osteosarcoma in adolescent with pathologic fracture. Methods: An 18-year-old girl presented with a painful mass in the right thigh of 4 months’ duration and a history of thigh bone fracture a month ago. Patient’s medical records and family history was unremarkable. Physical examination showed angulation and shortening at right femoral region with tenderness and swelling. Initial radiograph and magnetic resonance (MR) images showed multiple lesions in right femoral shaft and pelvic bone with primary tumor in right distal femur with pathologic fracture and multiple bone marrow lesions found in the contralateral bones. Imaging and histopathologic results supported the diagnosis of synchronous multifocal osteosarcoma. After following the chemotherapy as the treatment of choice, the radiograph and MRI evaluation were done and showed reduction of the mass size with union of the destructed part with the formation of callus. The advance MRI revealed reduction of the overall mass and the composition of the viable area compared to previous study. The patient had satisfying response to chemotherapy series and a better functional outcome on subsequent visits. Results: Diagnosis of synchronous multifocal osteosarcoma was based on patient and family history and finding of multiple lesions in the MR images, meanwhile the plain radiograph only revealed the primary tumor. Amstutz described multifocal osteosarcoma as presence of one primary tumor and several smaller lesions. Most recent reviews concluded that multifocal osteosarcoma is bone-to-bone metastatic process rather than multicentric origin. The limitation in this case was absence of thoracic CT which is suggested to rule out any pulmonary metastases instead of routine chest radiograph. Conclusions: Although satisfying improvement was clinically achieved, further advanced MRI would be indicated to evaluate the progression of tumor and its respond to therapy.

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Synchronous multifocal osteogenic sarcoma on multimodality imaging including bone scintigraphy

Cited by 8 publications

References 8 publications

Multiple myeloma mimicking primary bone tumour

Multiple myeloma mimicking primary bone tumour

Reconstruction using a frozen autograft for a skull and humeral lesion of synchronous multicentric osteosarcoma after undergoing successful neoadjuvant chemotherapy: a case report and review of the literature

Advance MR evaluation of synchronous multifocal osteosarcoma with pathologic fracture

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