3. OSTEOSARCOMAOSTEOSARCOMA
Osteosarcoma is primary malignant boneOsteosarcoma is primary malignant bone
forming tumorforming tumor
Common in young children and adolescents atCommon in young children and adolescents at
growing ends of bonesgrowing ends of bones
7. HIST0RYHIST0RY
An ancient disease present in Greek, EgyptianAn ancient disease present in Greek, Egyptian
& Indian literature.& Indian literature.
SARCOMA derived from Greek roots, meansSARCOMA derived from Greek roots, means
fleshy excrescence, used first time by Englishfleshy excrescence, used first time by English
Surgeon, JOHN ABERNATHY in 1804.Surgeon, JOHN ABERNATHY in 1804.
OSTEOSARCOMA, first time used by FrenchOSTEOSARCOMA, first time used by French
Surgeon, Alexis Boyer in 1805Surgeon, Alexis Boyer in 1805
(PERSONEL SURGEON TO NAPOLEON)(PERSONEL SURGEON TO NAPOLEON)
8. HISTORYHISTORY
1847,BORON GUILLAUME DUPUYTREN1847,BORON GUILLAUME DUPUYTREN
demonstrated gross pathologic appearance asdemonstrated gross pathologic appearance as
Osteosarcoma is a true cancerous degenerationOsteosarcoma is a true cancerous degeneration
of bone, manifest itself in the form of white orof bone, manifest itself in the form of white or
reddish mass, lardaceous and firm at an earlyreddish mass, lardaceous and firm at an early
stage of disease but presenting at latter stagestage of disease but presenting at latter stage
points of softening, cerebriform matter,points of softening, cerebriform matter,
extravasating blood, and white or strawextravasating blood, and white or straw
colored fluid of viscid consistence in itscolored fluid of viscid consistence in its
interior.interior.
9. HISTORYHISTORY
1900,VITTORIO PUTTI,SCAGLIETTI &1900,VITTORIO PUTTI,SCAGLIETTI &
COMPANACCI from ITLAY shaped treatment forCOMPANACCI from ITLAY shaped treatment for
Bone Tumor.Bone Tumor.
1921,ERNEST AMROY CODMAN &JAMES1921,ERNEST AMROY CODMAN &JAMES
EWING created registry for Bone Sarcoma.EWING created registry for Bone Sarcoma.
1950,HENRY L.JAFFE,LOUIS LICTENSTEIN1950,HENRY L.JAFFE,LOUIS LICTENSTEIN
established all key histological criteria used toestablished all key histological criteria used to
diagnose most of Bone Tumors.diagnose most of Bone Tumors.
10. HIST0RYHIST0RY
1970,NORMAN JAFFE, introduced1970,NORMAN JAFFE, introduced
Chemotherapeutic agents such asChemotherapeutic agents such as
METHOTREXATE & ADRIAMYCIN,METHOTREXATE & ADRIAMYCIN,
dramatically improved the treatment ofdramatically improved the treatment of
Osteosarcoma through their ability to treatOsteosarcoma through their ability to treat
Micro metastasis.Micro metastasis.
1976,ROSEN introduced Custom made1976,ROSEN introduced Custom made
Prosthesis.Prosthesis.
13. INCIDENCEINCIDENCE
Sixth leading cancer under age of 15Sixth leading cancer under age of 15
In USA 400 cases per Year.In USA 400 cases per Year.
(4.8 per Million <20 Y ),(4.8 per Million <20 Y ),
More common in black AmericansMore common in black Americans
Male 5.2 per Million per year,Male 5.2 per Million per year,
Female 4.2 per Million per yearFemale 4.2 per Million per year
Rare below 5 year(0.5 per Million per year)Rare below 5 year(0.5 per Million per year)
300 die in each year300 die in each year
22NDND
peak in incidence in Elderly, associated with Pagetpeak in incidence in Elderly, associated with Paget
disease, Bone infarct, or Post radiation.disease, Bone infarct, or Post radiation.
26. ETIOLOGYETIOLOGY
Exact cause is unknownExact cause is unknown
Risk factorsRisk factors
1;Rapid Bone Growth1;Rapid Bone Growth
2;2; RadiationRadiation
3;Genetic predisposition3;Genetic predisposition
27. ETIOLOGYETIOLOGY
Bone Dysplasias, including Paget Disease,
Fibrous Dysplasias, Enchondromatosis,
Hereditary Multiple Exostosis &
Retinoblastoma (Germ Line)
*Mutations in Tumor Suppressor Genes,P53
& Rb have major role in Osteosarcoma
development
30. PATHOLOGYPATHOLOGY
Localized at Metaphyseal ends of Long BonesLocalized at Metaphyseal ends of Long Bones
Solid, Hard, Irregular due to Tumor Spicules ofSolid, Hard, Irregular due to Tumor Spicules of
Calcified Bone, Surrounding Tissue infiltratedCalcified Bone, Surrounding Tissue infiltrated
31. PATHOLOGYPATHOLOGY
Microscopically, Tumor Cells are Pleomorphic,someMicroscopically, Tumor Cells are Pleomorphic,some
are Giant with numerous Mitosis, producingare Giant with numerous Mitosis, producing
Amorphous, Eosinophilic Osteoid with or withoutAmorphous, Eosinophilic Osteoid with or without
central Calcification.central Calcification.
46. CLINICAL PRESENTATIONCLINICAL PRESENTATION
Bone PainBone Pain
Most Common Symptom present atMost Common Symptom present at
night or afternight or after
exerciseexercise
SwellingSwelling
Decreased Joint MotionDecreased Joint Motion
Pathological FracturePathological Fracture
Respiratory symptomsRespiratory symptoms
Due to MetastasisDue to Metastasis
47. CLINICAL SIGNSCLINICAL SIGNS
MassMass
Palpable mass may or may not present,Palpable mass may or may not present,
may be warm & tender, firm to hard, increasedmay be warm & tender, firm to hard, increased
skin vascularity over mass.skin vascularity over mass.
Decreased Joint MobilityDecreased Joint Mobility
LymphadenopathyLymphadenopathy
Respiratory FindingsRespiratory Findings
48.
49.
50. DIAGNOSTIC TOOLSDIAGNOSTIC TOOLS
Plain X-RayPlain X-Ray
Total Body ScanTotal Body Scan
MRI of Primary TumorMRI of Primary Tumor
CT Scan LungCT Scan Lung
BiopsyBiopsy
Laboratory StudiesLaboratory Studies
79. PROGNOSISPROGNOSIS
5 year Survival ranges from 60% to 85%5 year Survival ranges from 60% to 85%
60 to 65% Treated 5 years ago (2000) will60 to 65% Treated 5 years ago (2000) will
be alive todaybe alive today
Stage 1 Osteosarcoma has goodStage 1 Osteosarcoma has good
prognosis >90% just requiresprognosis >90% just requires
SurgerySurgery
80. PROGNOSISPROGNOSIS
Stage 11b Prognosis dependsStage 11b Prognosis depends
1.1. Site of Tumor (worse for Axial Skeletal)Site of Tumor (worse for Axial Skeletal)
2.2. Size of Tumor Mass in cmSize of Tumor Mass in cm
3.3. Degree of necrosis from NeoadjuvantDegree of necrosis from Neoadjuvant
ChemotherapyChemotherapy
81. PROGNOSISPROGNOSIS
Stage 111 with Lung Metastasis,Stage 111 with Lung Metastasis,
overall Prognosis is 30% depends onoverall Prognosis is 30% depends on
1.1. Resectability of primary tumor& LungResectability of primary tumor& Lung
NodulesNodules
2.2. Degree of Necrosis of primary TumorDegree of Necrosis of primary Tumor
3.3. Number of MetastasisNumber of Metastasis
4.4. Duration of development of MetastasisDuration of development of Metastasis
