Extra-skeletal osteosarcoma: about a case
Summary
Extra-skeletal osteosarcoma is a rare soft tissue sarcoma usually occurring at the thighs and buttocks. His clinical diagnosis is difficult. Radiological signs are important to confirm the origin of the tumor at the soft tissue level. The key to the diagnosis is the anatomopathologic examination with the same morphological aspects described at the level of bone osteosarcoma. We report the case of a 64-year-old man who presented a recurrent tumor of the right thigh. Radiological examinations showed a large mass of soft tissues embedded in the hypodermic fat. Through this observation we will describe this rare tumor and we will discuss these characteristics pathology, clinical, radiological and therapeutic.
Keywords
Extra-Skeletal osteosarcoma anatomopathologic Extraskeletal osteosarcoma: A case Report
Abstract
Extraskeletal osteosarcoma is a rare soft tissue sarcoma that arise commonly in the thigh and buttock. This clinical diagnosis is difficult. Radiological funding is important to confirm the soft tissue origin of the tumor. The key of diagnosis is the pathological pattern with the same morphological funding in bone osteosarcoma. We describe a 64 years old men how presented a recurrent mass of the right hip. The radiological examination showed a large soft tissue mass enchaced in the subcutaneous flat. Pathological examination confirmed the diagnosis of Extraskeletal osteosarcoma. We liked with this observation to describe this rare tumor and to discuss these pathological, clinical, radiological and therapeutic features.
Keywords
Extraskeletal Osteosarcoma Pathology
Extra-skeletal osteosarcoma: about a case
Extraskeletal osteosarcoma: A case Report
K. Adam · I. Ekhiyat · S. Echerrif · B. Elkhanoussi
Received on 1 February 2015; Accepted on 22 February 2015
© Lavoisier SAS 2015
Summary the extra-skeletal osteosarcoma is a rare sarcoma
Soft tissue usually at the level of the
Thighs and buttocks. His clinical diagnosis is difficult.
Radiological signs are important to confirm the origin
Of the tumor at the soft tissue level. The key to diagnosis
Is the Anatomopathologic review with the same
Morphological aspects described at the level of the Osteosarcoma
Bone. We report the case of a 64-year-old man who
Presented a recurrent tumor of the right thigh. The exams
Showed a large mass of tissues
Soft embedded in the hypodermic fat. Through
This observation we will describe this rare tumor and
We will discuss these features pathology,
Clinical, radiological and therapeutic.
Extra-Skeletal Keywords · Osteosarcoma
Anatomopathologic
Abstract Extraskeletal osteosarcoma is a rare soft tissue sarcoma
That arise commonly in the thigh and buttock. This
Clinical diagnosis is difficult. Radiological funding is important
To confirm the soft tissue origin of the tumor. The Key of
Diagnosis is the pathological pattern with the same morphological
Funding in bone osteosarcoma. We describe a 64 years
Old Men how presented a recurrent mass of the right hip. The
Radiological examination shown a large soft tissue mass
Enchaced in the subcutaneous flat. Pathological examination
Confirmed the diagnosis of Extraskeletal osteosarcoma. We
Liked with this observation to describe this rare tumor and to
Discuss these pathological, clinical, radiological and therapeutic
Features.
Extraskeletal Keywords · Osteosarcoma Pathology
Introduction
Extra-skeletal osteosarcoma (OSES) or osteosarcoma
Soft tissue is defined by the World Organization
Health (WHO) as: a mesenchymal tumor
Malignant soft tissue composed of neoplastic cells
That reproduce the phenotype of osteoblasts and synthesize
of the bone. As a result all the OSES contain
The neoplastic bone, but they may contain components
Cartilage and fibroblastic [1]. For a tumor to
is defined as a dare, it must be born in the
Level of soft tissue without attachment to the bone or
Periosteum. It must have a uniform sarcomateux aspect and
produce a matrix osteoid and/or cartilaginous [2].
The OSES is a rare tumor and represents 3.7-4.6% of
Osteosarcomas and 1.2% of soft tissue sarcomas [3].
His diagnosis is based on data from radiology and
Confirmed by the anatomopathologic exam.
Observation
64-year-old man presenting a clinical history evolving
For three years by the appearance of a mass of the thigh
Right. In these antecedents there is no concept of trauma
or irradiation. The mass was resected. The evolution
Was marked by the recurrence of mass after six months
In the form of a ulcerated mass and the patient was sent to
Our training. The clinical examination was a
ulcerated and painful right thigh mass. The CT scan
(TDM) objected to a large mass of tissues
Irregularly contoured, embedded at the level of the
Hypodermic fat, infiltrating and ulcérant the skin
Look. Magnetic resonance imaging (MRI) showed
Heterogeneous mass in hyper-signal after administration
Of the contrast product in T2 sequence. Angiography
Showed a hyper-vascularized mass without bone attachment
(Fig. 1a and B). A wide resection of the mass was carried out.
Results
The macroscopic examination focused on a tumor of
15x7x5 cm, ulcerated on the surface. The section slice showed
The presence of bone tissue in the center of the tumor (Fig. 2).
Microscopically It was a tumor formed of spans
Bone and osteoid developed by fusiform cells
Pleomorphic anaplastic, with the presence of a few cells
Giants and figures of mitosis. Areas with differentiation
Chondroid have been noted (Fig. 3a and B). The margins
of resections passed into healthy areas and tumor resection
was considered complete. The evolution was without incident.
Discussion
The OSES is a rare tumor, described for the first time by
Wilson in 1941. It's a mesenchymal tumor.
A malignant beginning at the level of soft tissue without
Connection to skeleton structures. It is composed
of cells producing osteoid material, bone and/or
Chondroid [4]. It is a rare tumor and only represents
1 to 2% of all soft tissue sarcomas [1, 3, 5].
Unlike the bone osteosarcoma that occurs mainly
In the first two decades, the OSES usually occur
From the fifth to the sixth decade [3]. The
Gender impact results vary and the prevalence of
In man and woman has been reported. Lee and
Al found a M/F sex ratio of 1.9/1.0 [6]. The etiology
Of this tumor remains unknown and is presumed to be
That it is essentially a idiopathic phenomenon.
There are a number of risk factors such as
Radiation exposure and trauma. Some cases
were associated with intramuscular injection. It has been reported
Cases of OSES occurring after a myositis Ossificans
[6.7]. Most authors consider that the cells
Mesenchymal multipotent are transformed into osteoblasts
Allo-typical leading to the development of
The OSES [8]. The majority of the OSES are born
Deep soft tissue level and < of 10% are superficial
Originating in the dermis or Hypodermis [1]; As
That was the case with our patient. Although the tumor may
occur in any part of the body, approximately
75% of the OSES are located at the extremities
Lower levels especially in the buttocks and
Thigh. Other locations include retro-peritoneum and
The upper extremities [2]. Rarely the tumor can sit
At the level of the breast, lung, prostate, cord
Spermatic, the pelvis, the penis and the orbit [8].
Clinically there are no specific signs. Generally
The tumor presents itself as a mass of tissues
Gradually increasing in size. Can be
associated with pain in about 1/3 of cases. The
Large and long-lasting tumors can
Be ulcerated. Usually the ulceration appears after
A biopsy or surgical gesture as was the case for
Our patient. The duration of the symptoms varies from
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