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Osteosarcoma is a highly malignant tumor that Arises within the bone and spreading rapidly outward. CT scanning helps delineate the location and extent of the tumor and is critical for surgical planning. Obtain the CT scan of the chest before performing a biopsy to avoid ambiguity that can arise from postanesthesia atelectasis. Radionuclide bone scanning with technetium-99 is important to evaluate for the presence of metastatic or multifocal disease with a bone scan
Osteosarcoma is a highly malignant tumor that Arises within the bone and spreading rapidly outward. CT scanning helps delineate the location and extent of the tumor and is critical for surgical planning. Obtain the CT scan of the chest before performing a biopsy to avoid ambiguity that can arise from postanesthesia atelectasis. Radionuclide bone scanning with technetium-99 is important to evaluate for the presence of metastatic or multifocal disease with a bone scan
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Osteosarcoma is a highly malignant tumor that Arises within the bone and spreading rapidly outward. CT scanning helps delineate the location and extent of the tumor and is critical for surgical planning. Obtain the CT scan of the chest before performing a biopsy to avoid ambiguity that can arise from postanesthesia atelectasis. Radionuclide bone scanning with technetium-99 is important to evaluate for the presence of metastatic or multifocal disease with a bone scan
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai PPT, PDF, TXT atau baca online dari Scribd
Arises within the bone and spreading rapidly outward.
Predominantly in children and adolescents. Mostly involves the long bone metaphyses. Etiology
Rapid bone growth
Environmental factors( exposure to radiation)
Genetic predisposition(Paget disease, fibrous
dysplasia, enchondromatosis, and hereditary multiple exostoses and retinoblastoma) common sites femur (42%, 75% of which are in the distal femur) tibia (19%, 80% of which are in the proximal tibia) humerus (10%, 90% of which are in the proximal humerus). the skull and jaw (8%) pelvis (8%). Clinical features Pain .(constant, worse at night) Lump. Pathological fracture.(telangiectatic type) Physical examination findings 1. Mass(may be tender and warm) 2. Decreased range of motion 3. Lymphadenopathy 4. Respiratory findings Imaging Studies plain x -ray
Osteosarcoma lesions 1. purely osteolytic ( 30% ) 2. purely osteoblastic (45%) 3. a mixture of both.
Hazy osteolytic areas may alternate with dense osteoblastic
areas. The endosteal margin is poorly defined. “sunburst” effect(As the tumour mass expands new bone forms along vascular channels) Codman’s triangle. CT scanning helps delineate the location and extent of the tumor and is critical for surgical planning.
obtain the CT scan of the chest before performing a
biopsy to avoid ambiguity that can arise from postanesthesia atelectasis. MRI The best method to assess the extent of intramedullary disease as well as associated soft-tissue masses and skip lesions. The single most important study for accurate surgical staging of the lesion with use of the Enneking staging system. Radionuclide bone scanning with technetium-99 (99m Tc It is important to evaluate for the presence of metastatic or multifocal disease with a bone scan. Osteosarcoma with interrupted periosteal rection and Codman triangle proximally. There is periosteal bone formation perpendicular to the cortical bone and extensive bony matrix formation by the tumor itself. The serum alkaline phosphatase may be raised (osteoblastic tumors )but is often normal in the lytic examples. A rise in alkaline phosphatase following excision may herald a recurrence. Lactate dehydrogenase (to monitor recurrence) Beta human chorionic gonadotropin Pathology Situated in the metaphysis of a long bone. Areas of bone loss and cavitation alternate with dense patches of abnormal new bone. Extends within the medulla and across the physeal plate. high-grade, anaplastic tumors Osteoblastic, chondroblastic, and fibroblastic differentiation is commonly admixed may be plasmacytoid, epitheloid, spindled, or oval. Normalization(tendency of the osteoblasts to become smaller and less pleomorphic as they get incorporated into the osteoid) Catilages cells or fibroblastics tissue with little or no osteoid. Medical Therapy
neoadjuvant (preoperative) chemotherapy has been
found not only to facilitate subsequent surgical removal by causing tumor shrinkage. Patients receiving methotrexate should not be given folate supplementation or Bactrim, both of which interfere with the effects of methotrexate. Surgical Therapy
definitive resection- margins on all sides of the tumor
must contain normal tissue (wide margin). Amputation may be the treatment of choice in some circumstances. If possible, a number of options exist for limb-salvage reconstruction, which must be chosen based on individual considerations, as follows: 1. Autologous bone graft( may be vascularized or nonvascularized) 2. Allograft 3. Prosthesis 4. Rotationplasty Differential diagnosis Osteoblastomas Fracture Callus Giant cell tumor (GCT) Malignant Fibrous Histiocytoma Osteogenic Melanoma