Updated: 12/27/2021

Osteosarcoma

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
0%
0%
Evidence
5
0
0
0%
0%
Videos / Pods
1
Topic
Images
https://upload.medbullets.com/topic/120473/images/codman_triangle12osteo..jpg
https://upload.medbullets.com/topic/120473/images/sunburstosteosarcoma..jpg
https://upload.medbullets.com/topic/120473/images/osteosarcoma_-_intermed_mag.jpg
  • Snapshot
    • An 13-year-old boy presents to his pediatrician for right distal thigh pain. He has been having pain in this area for the past few months, has progressively worsened, and persists in the night. Physical examination is notable for tenderness upon palpation above the right knee. A radiograph of the distal thigh demonstrates a sunburst pattern and Codman triangle.
  • Introduction
    • Overview
      • malignant bone tumor secondary to overproduction of osteoid cells by malignant cells
        • most commonly affecting the metaphysis of bone
  • Epidemiology
    • Incidence
      • bimodal age distribution
        • adolescence and adults > 65 years of age
    • Risk factors
      • Paget disease of the bone
      • prior irradiation or chemotherapy
      • familial retinoblastoma
      • Li-Fraumeni syndrome
      • teriparatide use
  • ETIOLOGY
    • Pathophysiology
      • unclear
    • Associated conditions
      • Paget disease of the bone
      • familial retinoblastoma
      • Li-Fraumeni syndrome
  • Symptoms
    • Symptoms
      • localized pain
        • typically over several months
        • location
          • metaphyseal regions
            • distal femur
            • proximal tibia
            • proximal humerus
      • systemic symptoms are generally absent
        • e.g., weight loss, fever, and nightsweats
    • Physical exam
      • may have a mass at the site of involvement
  • Imaging
    • Radiography
      • indication
        • initial imaging study
      • finding
        • Codman triangle
          • periosteal new bone formation
        • radiodense and radiolucent areas with bone cortex destruction
          • mostly in the metaphyseal region of bone
        • sunburst appearance
          • new bone formation perpendicular to the shaft of the bone
    • MRI
      • indication
        • to determine the extent of disease
          • important to do the involved entire long bone to find any skip lesions
    • Radionuclide bone scan
      • indication
        • to evaluate for metastatic disease
  • Studies
    • Invasive studies
      • open or core biopsy
        • indication
          • used to confirm the diagnosis
    • Histology
      • findings
        • pleomorphic osteoid-producing cells
  • Differential

    • Ewing sarcoma
      • differentiating factors
        • anaplastic small, round, and blue cells with scant cytoplasm
        • typically affects the diaphysis
  • Treatment
    • Treatment consists of surgical resection (even amputation), chemotherapy, and radiation therapy
      • depends on the grade and extent of the disease
  • Complications
    • Metastasis
    • Amputation
  • Prognosis
    • Prognostic variable
      • positive
        • low-grade
        • negative resection margin
      • negative
        • metastasis
        • unresectable or partially resectable
        • large tumor size

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (0)
Cards
1 of 0
Questions (1)

(M2.ON.15.16) An 11-year-old boy with a history of attention deficit disorder presents to a general medicine clinic with leg pain. He is accompanied by his mother. He reports dull, throbbing, diffuse pain in his bilateral lower extremities. He reports that the pain feels deep in his muscles. He has awakened several times at night with the pain, and his symptoms tend to be better during the daylight hours. He denies fatigue, fever, or pain in his joints. On physical examination, his vital signs are stable, and he is afebrile. Physical examination reveals full range of motion in the hip and knee joints without pain. He has no joint effusions, erythema, or warmth. What is the next best step in management?

QID: 105414

Lower extremity venous ultrasound

0%

(0/24)

MRI of the knees

4%

(1/24)

Xray of the knees

4%

(1/24)

Send ESR and CRP

12%

(3/24)

Reassurance

75%

(18/24)

M 6 E

Select Answer to see Preferred Response

Evidence (5)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (4)
Private Note