Osteogenic sarcoma develops from cells of the mesenchymal series, which form neoplastic osteoid and osseous tissue either directly or indirectly by rapid growth of development.
The classic osteogenic sarcoma develops in the interior of a bone. Juxta-cortical osteogenic sarcoma develops in relation to the periosteum and immediate parosteal connective tissue. It is less common, but has a much better prognosis. Endosteal osteo-sarcoma is a variant of parosteal osteosarcoma that arises within bone from the endosteum, a low-grade malignant tumor that grows slowly and metastasizes late.
Telangiectatic osteosarcoma is a high-grade malignant lesion that shows
- Minimal ossification
- Cystic and necrotic changes
- Rapid growth
- Weakened by the rapid destructive osteolytic process often resulting in fractures
Generally, the tumor occurs in the age group of 10 to 25 years, though it can occur in as young as 5 years and as old as 50 years. In an older person, the possibility of malignant transformation of a pre-existing benign bone disease such as Paget’s disease of bone or fibrous dysplasia should be considered.
The tumour occurs equally in males and females.
The tumor occurs in metaphyseal region of a long bone but on occasion may be diaphyseal in its site. The most common sites are the lower end of the femur and the upper end of the tibia. The upper ends of the humerus and the femur are next in frequency of localization. On a rare occasion, it may be encountered in the fibula, pelvic bones, or in encountered in the fibula, pelvic bones, or in the vertebral column. Occurrence in the distal part of a limb (hand or foot) is extremely rare.
The tumor has been described in every bone in the body. Multiple or multicentric osteogenic sarcoma.
Pathologic Findings
The tumor ordinarily begins in the medullary cavity of a long bone near the metaphysis. By the time it is recognized, it has already penetrated and extended through the cortex raising the periosteum. In advanced cases, the periosteal barrier may be broken, and one may find a soft-tissue tumor mass invading the contiguous muscle tissue.
Central portion of the neoplasm displays greater ossification than do the peripheral areas. The ossified portions are of a gritty and yellowish. The boundaries of the epiphyseal end of the tumor are not clearly distinguishable.
The physis remains unbroken until later in the course of the disease. Also the articular cartilage serves to block the extension of the neoplasm into the joint. Skip extension may occasionally occur.
Microscopic examination shows the presence of a frankly sarcomatous stroma and direct formation of neiplastic osteoid and bone.
The microscopic picture is of four types.
- Osteoid production is the predominant findings
- Osteoid and cartilage are formed
- Neither osteoid nor cartilage is produced, but collagen is formed
- There is little or no indication of the presence of these intercellular substances.
There is no correlation between clinical performance of osteogenic sarcoma and microscopic type.
Clinical Findings
Symptoms
- Local pain in the affected part.
- Initially, the pain is intermittent, but within a matter of weeks, becomes severe and constant.
- There may be a history of trauma that has precipitated discomfort from the tumor.
- Anntalgic limp in case of lower limb.
Signs
- Local swelling that is hard and fixed
- Increased local heat and sensitivity to pressure.
- Firmness of the swelling varies, depending on the extent of ossification.
Limitation of joint motion and disuse atrophy of the muscles are other findings.
A pathologic fracture through the lesion may be the presenting condition.
The general heatlh of the child is usually fair except for in the cases where pulmonary metastases have already occurred in the early stages.
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