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    Osteosarcoma

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    Stephen Jao Ayala Ujano
    Osteosarcoma is the most common primary malignant bone tumor in children and adolescents that produces unmineralized bone or osteoid. It has a male predominance and typically presents with thigh or knee pain that worsens with activity. Diagnosis involves imaging like plain radiography, MRI, and CT to identify features like sunburst patterns and assess tumor extent. Treatment involves neoadjuvant chemotherapy, surgery to remove the tumor, and sometimes additional chemotherapy or radiation. Prognosis depends on tumor grade and response to chemotherapy.

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    Osteosarcoma

    Uploaded by

    Stephen Jao Ayala Ujano
    117 views3 pages
    Osteosarcoma is the most common primary malignant bone tumor in children and adolescents that produces unmineralized bone or osteoid. It has a male predominance and typically presents with thigh or knee pain that worsens with activity. Diagnosis involves imaging like plain radiography, MRI, and CT to identify features like sunburst patterns and assess tumor extent. Treatment involves neoadjuvant chemotherapy, surgery to remove the tumor, and sometimes additional chemotherapy or radiation. Prognosis depends on tumor grade and response to chemotherapy.

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    Osteosarcoma

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    Osteosarcoma is the most common primary malignant bone tumor in children and adolescents that produces unmineralized bone or osteoid. It has a male predominance and typically presents with thigh or knee pain that worsens with activity. Diagnosis involves imaging like plain radiography, MRI, and CT to identify features like sunburst patterns and assess tumor extent. Treatment involves neoadjuvant chemotherapy, surgery to remove the tumor, and sometimes additional chemotherapy or radiation. Prognosis depends on tumor grade and response to chemotherapy.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    117 views3 pages

    Osteosarcoma

    Uploaded by

    Stephen Jao Ayala Ujano
    Osteosarcoma is the most common primary malignant bone tumor in children and adolescents that produces unmineralized bone or osteoid. It has a male predominance and typically presents with thigh or knee pain that worsens with activity. Diagnosis involves imaging like plain radiography, MRI, and CT to identify features like sunburst patterns and assess tumor extent. Treatment involves neoadjuvant chemotherapy, surgery to remove the tumor, and sometimes additional chemotherapy or radiation. Prognosis depends on tumor grade and response to chemotherapy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    OSTEOSARCOMA

    A spindle cell neoplasm that produces osteoid


    (unmineralized bone) or bone

    Epidemiology:
    Most common primary malignant bone tumor
    in children & adolescents (2nd decade of life)60%
    Male to female ratio (1.5-2:1)
    10% occurs in the 3rd decade of life
    5th or 6th decade of life is frequently secondary
    to either radiation therapy

    Diagnostics:
    Plain radiography
    - Osteosarcoma lesions can be purely
    osteolytic (~30% of cases), purely
    osteoblastic (~45% of cases), or a
    mixture of both
    - Classic radiographic appearance of
    osteosarcoma is the sunburst pattern

    Etiology:
    DNA mutation cause by carcinogens
    Hereditary
    Pathophysiology:
    - Trauma
    - Irradiation
    - Pagets disease of the bone
    - Fibrous dysplasia
    - Osteochondroma
    high grade
    (conventional)
    osteosarcoma

    arise in
    diaphyseal
    region of the
    bones

    Clinical Manifestation:
    - Chronic
    - Right thigh/ knee pain
    - Limited motion
    - Swelling and tenderness
    - Joint effusion
    - Generalized weakness
    - Inability to ambulate
    - Weight loss
    - Easy fatigability
    - Aggravated by activity
    - No relief after intake of NSAID

    invade
    medullary
    cavity

    2 variants must be distinguished from conventional


    1. Parosteal osteosarcoma
    - Low grade
    - Well differentiated tumor
    - Most commonly found in posterior
    aspect of femur
    - Does not invade medullary cavity
    2. Periosteal osteosarcoma
    - Arise in the surface of bone
    - Higher rate of metastatic spread than
    parosteal

    MRI
    -

    best method of assessing the extent of


    intramedullary disease, as well as
    associated soft-tissue masses and skip
    lesions

    Computed tomography
    - CT of the primary lesion helps delineate
    the location and extent of the tumor
    and is critical for surgical planning
    - CT of the chest is more sensitive than
    plain film radiography is for assessing
    pulmonary metastases

    Ultrasonography
    - not routinely used in the staging of
    classic osteosarcoma lesions. The
    modality may be useful in guiding
    percutaneous biopsy.

    Treatment
    CHEMOTHERAPY
    - NEO-ADJUVANT CHEMOTHERAPY: CT
    ADMINISTERED BEFORE THE SURGICAL
    RESECTION OF PRIMARY TUMOUR
    - ADJUVANT CHEMOTHERAPY: CT
    ADMINISTERED POSTOPERATIVELY TO
    TREAT PRESUMED MICRO-METASTASIS
    SURGERY - THE MAINSTAY OF THERAPY
    - LIMB SACRIFICING SURGERY
    - LIMB SALVAGING SURGERY
    RADIOTHERAPY
    - EXTERNAL BEAM RADIATION BY LINEAR
    ACCELERETER.
    - BRACHYTHERAPY LIMITED ROLE
    - IORT SINGLE DOSE, IN SPECIALLY
    PREPARED OT

    ACUTE CRUCIATE LIGAMENT TEAR

    runs diagonally in the middle of the knee.


    It prevents the tibia from sliding out in front of
    the femur
    Provides rational stability to the knee & control
    the back and forth motion of the knee

    Epidemiology:
    Most commonly injured knee ligament
    78% of sports-related injuries
    Female athletes

    Histologic examination of the tumor


    - Two elements are important to the
    histologic examination of the tumor:
    first, tumor type, can be assessed on
    the biopsy; second, response to
    treatment, can be assessed on the
    definitive resection following
    chemotherapy

    Etiology:
    High risk sports (changing direction rapidly,
    stopping suddenly, slowing down while running,
    landing from a jump incorrectly
    Direct contact (tackle/ trauma)
    Pathophysiology:
    trauma,
    overextended
    knee joint,
    sports

    bones of the
    legs twist in
    opposite
    directions

    leading to ACL
    tear

    Clinical Manifestation:
    - Limited motion
    - Swelling and tenderness
    - Joint effusion
    - Inability to ambulate
    - Aggravated by activity
    - Alleviated by rest
    - No relief after intake of NSAID
    Diagnostics:
    Lachman Test
    - Most sensitive test for acute ACL rupture
    - Performed with the knee in 30 of flexion,
    with the patient lying supine
    - Amount of displacement (mm) and the
    quality of endpoint are assessed (firm,
    marginal, soft)
    - Abnormal: >3mm
    - ACL tear: Asymmetry in side to side laxity
    or soft endpoint

    Pivot Shift Test


    - Performed with the leg extended and the
    foot in internal rotation, and a valgus stress
    is applied to the tibia

    Anterior Drawer Test


    - Performed with the t 90 flexion, with the
    patient lying supine
    - There is an attempt to displace tibia
    forward from the femur
    - ACL tear: >6mm of tibial displacement
    : positive only in 77% of patients with
    complete ACL rupture

    MRI
    - Sensitivity of 90-98%
    - May identify bone bruising which is present
    in 90% of ACL injuries
    - Should not be used as a substitute for a
    good history and physical examination

    treatment
    Non-operative
    o May be considered in elderly patients
    or in less active athletes who may not
    be participating in any pivoting type of
    sports (running, cycling)
    Arthroscopy
    o Considered for persons who are poor
    candidates for reconstruction but have
    a mechanical block to range of motion
    o
    Medications
    o Analgesics
    NSAIDs
    COX-2 inhibitors

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