OSTEOSARCOMA

Kadek Gede Bakta Giri

DEFINITIONS

• A highly malignant tumor arising within the bone and

spreading rapidly outwards to the periosteum and
surrounding soft tissues.
• Mesenchymal malignancy (malignant spindle cells) that
differentiates to produce osteoid/immature bone.
INCIDENCE

• 2nd most common malignant bone tumor

• The 1,952 osteosarcomas accounted for 27.5% of all malignant
tumors and 19.2% of all bone tumors.
• Predominantly in children and adolescents
 SEX AGE
• Approximately 58% of the • A few patients with
patients with osteosarcoma were osteosarcomas are in the first
male. decade of life.
• Peak incidence second decade
(44.7%).
LOCALIZATION

• The metaphyseal part of the long bones is the site of

predilection,
• Almost one-half of the osteosarcomas in the Mayo Clinic series
were in the region of the knee.
• Distal femur and proximal tibia.
ACCORDING TO AGE AND SEX OF THE
PATIENT AND SITE OF THE LESION
AGE DISTRIBUTION
SECONDARY OSTEOSARCOMA:

• Occurs in old people

• Associated with Paget’s disease or chronic
osteomyelitis
• Highly aggressive
DISTRIBUTION OF OSTEOSARCOMAS
IN PATIENTS 60 AND OLDER
SYMPTOMS

• Pain : may be intermittent

• Swelling (cardinal symptom)
• Pathological fracture
• Fever
• May can asymptomatic
PHYSICAL FINDINGS

• A painful mass on affected region

• Mass can very large
• Swelling
• May be associated with overlying prominent
veins
• Edema distal to the lesion
 LABORATORY

• CBC
• ESR and CRP
• Lactate Dehydrogenase (LDH)
• Elevated Alkaline Phosphatase (ALP) may 2-3 times
 IMAGING

• Radiographs
• sun-burst or hair on end pattern of matrix mineralization
• periosteal reaction (Codman's triangle)
• large soft tissue mass with maintenance of bone cortices

• MRI
• soft tissue involvement
• neurovascular involvement
• presence skip metastases

• Bone Scan
• very hot in osteosarcoma
• useful to evaluate extent of local disease and presence of bone
metastases

• CT Scan
• Chest CT scan for evaluate pulmonary metastase
BLASTIC AND DESTRUCTIVE
LESION (SUN-BURST)
CODMAN TRIANGLE
 HISTOPATHOLOGY FEATURES

• Lichtenstein tersely stated the essential criteria as:

(1) the presence of a frankly sarcomatous stroma
(2) the direct formation of tumor osteoid and bone by this malignant
connective tissue.

• Osteosarcomas can be divided rather conveniently into

osteoblastic, chondroblastic, and fibroblastic groups.
• v
 TREATMENT

Non Operative Operative

• Chemotherapy • Disarticulation
• Amputation
• Resection with
reconstruction/endoprosthesis
• Limb salvage surgery
• Resection of metastatic lesion
(lobectomy in lung)
 CHEMOTHERAPY

• Doxorubicin
• Cisplatin
• Ifosfamide
• Methotrexate
• Cyclophosphamide
 LIMB SALVAGE SURGERY

• Principle is to eradicate the bone tumor, retain integrity of

skeletal system and preserve the limb with useful function.
• After resection, skeletal reconstruction done by bone
grafting(auto or allograft) or by endoprosthesis (modular or
custom made).
• Prosthetic reconstruction is more effective
• As compared to the radical amputation and external prosthetic
fitting or limb sparing surgery with bone grafting this
treatment is more effective in early mobilization.
THANK YOU