FOR MEDICAL STUDENTS (BEST)

SARCOMA CLINICAL
CASES
Professional clinical cases (2)

1/1/2016

GIVES YOU BRIEF ANSWERS OF IMPORTANT QUESTION FOR PATHOLOGICAL CLINICAL CASES
FACED USUALLY BY MEDICAL PRACTIONERS OR STUDENTS.
 SARCOMA CASES

Case 1

A 17-year-old white boy presented to physician at Horizon hospital with

a history of insidious, often transitory pain in the left knee, which
had persisted over the last 6 months. He reported that he had
been kicked on the knee during a high school soccer match, and he
thought that the joint had never recovered from that insult. Over the last
several weeks, the pain had become more persistent and intractable,
and he thought that there was some swelling just below the knee.

On physical examination, the physician could palpate a hard, bony

expansion in the proximal tibia. The mobility of the knee joint was
normal. Radiographs revealed a large clear area in the tibia, which
focally destroyed the cortex. A biopsy of the bone lesion and a chest
radiograph were ordered.
The core biopsy specimen revealed varied histopathology. In some
sections of the mass, malignant cells surrounded
by osteoid predominated, whereas in other sections, malignant cells
embedded in cartilaginous matrix predominated. In other sections, large
numbers of giant cells were seen. This varied histologic profile presented
a diagnostic dilemma to the junior pathology resident. He scheduled a
consultation with the attending orthopedic pathologist to help formulate a
final diagnosis.

Questions:
1- What is the likely diagnosis by the consultant?
2- What is the significance of trauma in this case?
3- Is this tumor a primary or secondary osteosarcoma?
4- Enlist some methods for diagnosis?
5- Which organ is the preferential site for metastases in patients
with osteosarcoma?
Answers:

1- Osteosarcoma
2- Osteosarcoma generally manifests with severe, local pain,
although in some cases protracted, slowly developing, slight-to-
moderate pain and tenderness may be observed. The tumors
occur in young, active patients who may have concurrent trauma
to bones and joints, and the patient may not seek prompt medical
attention.
3- This is a secondary osteosarcoma.
4- Some tests are:
a) Alkaline phosphate test.
b) Radiography.
c) Biopsy.
d) CT scan.
e) MRI.
5- The lungs are the preferential site for metastases in patients with
osteosarcoma.

Distal femur, primary osteosarcoma - Gross, cut surface

This is a classic example of primary osteosarcoma. The tumor is from a young patient (growth plate is
still evident). Primary osteosarcomas characteristically arise in the metaphysis and destroy the cortex.
It is rare for the tumor to extend into the joint.
 Case 2

Adult of about 60 years old appearing fat cells and more primitive on his
body having no pain in them but morphologically well-differentiated.
There appears lesions and at the site of deep soft adipose tissues. He is
checked at Horizon hospital by a pathologist. The pathologist ordered
radiography and biopsy.

Reports shows well-differentiated tumors grow slowly and are associated

with a more favorable outlook, characterized by abundant, mucoid
extracellular matrix.

Then he referred to the consultant for like diagnosis and treatment.

Questions:

1- What will be the likely diagnosis?

2- What is the type—malignant or benign?
3- What are the main looking symptoms?
4- Differentiate briefly carcinoma and sarcoma?
5- Is this a genetically induce tumor?

Answers:

1- Liposarcoma is the like diagnosis.

2- It is a malignant tumor because it causes metastasis with lungs
after a time, and patient may die by it.
3- The main site is soft adipose tissue, characterized by well-
differentiated fat cells looking clear and morphologically
changed.
4- Carcinoma: the malignant tumor of epithelial cell origin. E.g.
renal cell carcinoma. Whereas
Sarcoma: the malignant tumor of Mesenchymal tissue. E.g.
adipose tissues.
5- Yes, chromosomal translocation is associated with liposarcoma;
this rearrangement creates a fusion gene encoding an
abnormal transcription factor that may interfere with adipocyte
differentiation.