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METASTATIC OSTEOSARCOMA

Posted Tue, 12/01/2009 - 11:45 by Mehmet Ruhi Onur

Images

Figure 1

Figure 2

Figure 3

Figure 4

Clinical History:

A 50-year old female patient presented to our clinic for the evaluation of esophageal perforation. She has past history of osteosarcoma of the left femur. She is status post surgery 2 years.

Findings:

Fıgure 1: Coronal CT scan. An ossified mass is seen in the epigastrium containing esophagus

and extending to the thorax and diaphragm. The density value of 991 HU reveals

ossification.

Figure 2: Coronal CT image shows that mass located in the distal esophagus at

the infradiaphragmatic level is compressing the stomach inferiorly (arrow).

Figure 3: On this axial view, ossified mass is located at the distal esophagus level and

extending anteriorly. The mass encircles aorta but does not invade it.

Figure 4: Axial view of chest CT shows ossification in left hemithorax.

(arrow).

Diagnosis:

METASTATIC OSTEOSARCOMA

Discussion:

Osteosarcoma is a malignant primary bone tumor. The lung is the most frequent site of metastases, accounting for about 80% of relapses. With the advent of adjuvant chemotherapy, the pattern of metastatic spread of osteosarcoma has altered. With prolonged survival, extrapulmonary metastases are now becoming more common clinically.
The differential diagnosis of a calcified intrathoracic lesion includes metastasis from metaplastic carcinoma of the breast; germ cell tumor; primary pulmonary carcinoma; primary pulmonary sarcoma such as osteosarcoma, chondrosarcoma, synovial sarcoma, or undifferentiated sarcoma; calcified hemangioma; and pseudotumor. Extrapulmonary sites for metastases in osteosarcoma include bone, brain, pleura, liver, kidneys, pancreas, subcutaneous fat and lymph nodes. Even extrapulmonary thoracic manifestations of osteosarcoma metastases are described in the literature. The metastatic lesions described here are rare in literature. Also a lesion traversing from thorax to abdomen through diaphragm has never been reported before.
This hyperdensity can mimic extravasation of oral contrast and measurement of HU units is important to differentiate it from bony metastatic lesion (Figure 1).

References / Suggested Reading:

1.Overberg-Schmidt U.S, Bassir C, Becker M, Unger M, Henze G. The stomach and
pulmonary interlobular space as unusual sites of osteosarcoma. Pediatric Hematology
and Oncology 1999; 16:61-66
2.Bacci G, Ruggieri P, Picci P et al Changing pattern of relapse in osteosarcoma of the extremities treated with adjuvant and neoadjuvant chemotherapy. J Chemother 1995; 7:230–239
3.Giuliano AE, Feig S, Eilber FR. Changing metastatic patterns of osteosarcoma. Cancer 1984; 54:2160–2164
4.Kim SJ, Choi JA, Lee SH et al Imaging findings of extrapulmonary metastases
of osteosarcoma. Clin Imaging 2004; 28:291–300.
5.Tiemessen MA, de Bruin PC, Wiarda BC et al. A massive calcified mass in the lung. Chest 2003; 124:2010–2013.

6. Kim I, Kim WS, Yeon KM et al Inflammatory pseudotumor of the lung manifesting as a posterior mediastinal mass. Pediatr Radiol 1992; 22:467–468.

Author

Mehmet Ruhi Onur

Assistant Professor

University of Firat Faculty of Medicine Department of Radiology

Category:
- GI Radiology

Wed, 12/02/2009 - 16:50

Vikram Dogra

Offline

Joined: 05/23/2007

Excellent case

Thank you for your submission.

Dr. Vikram Singh Dogra

Professor of Radiology, Urology & BME
Associate Chair for Education and Research.
Department of Imaging Sciences
University of Rochester School of Medicine

Mon, 12/14/2009 - 11:51

husam wahbeh