Osteosarcoma (1)

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Osteo = bone/osteoid tissue Sarcoma = malignant tumour of connective tissue 02/04/12 Dr. Pruthviraj Nistane Deptt. Of Orth...

Overview <ul><li>Definition </li></ul><ul><li>Epidemiology </li></ul><ul><li>Pathogenesis </li></ul><ul><li>Skeletal distr...

What is osteosarcoma ? <ul><li>Highly malignant tumor of mesenchymal origin. </li></ul><ul><li>Spindle shaped cells that p...

Epidemiology <ul><li>Incidence – 1 to 3 per million per year </li></ul><ul><li>Any age </li></ul><ul><li>But 75% in 12-25...

Epidemiology <ul><li>Associated syndromes </li></ul><ul><li>Hereditary form of retinoblastoma </li></ul><ul><li>Li-Fraume...

Pathogenesis <ul><li>Unknown </li></ul><ul><li>Modal incidence correlates with rapid bone growth </li></ul><ul><li>Radiati...

Gross pathology <ul><li>Arise from multipotent mesenchymal cells </li></ul><ul><li>Mixture of osteoid, fibrous, cartilagin...

Gross pathology <ul><li>Metaphyseal, Central. </li></ul><ul><li>Extension into medullary cavity and subperiosteal extensio...

Microscopic appearance <ul><li>Stroma - Malignant connective tissue with anaplastic spindle cells </li></ul><ul><li>Matrix...

Classification <ul><li>PRIMARY or SECONDARY </li></ul><ul><li>PRIMARY OSTEOSARCOMAS are </li></ul><ul><li>Conventional /cl...

Classification <ul><li>SECONDARY OSTEOSARCOMAS </li></ul><ul><li>Osteosarcomas occurring at the site of another disease p...

Classic High Grade Osteosarcoma <ul><li>These aggressive, high-grade tumors begin in an intramedullary location, but may b...

Skeletal distribution <ul><li>Distal femur </li></ul><ul><li>Proximal tibia </li></ul><ul><li>Proximal humerus </li></ul><...

Clinical Presentation <ul><li>Pain – progresssive pain </li></ul><ul><li>due to microinfarction </li></ul><ul><li>night ...

Evaluation <ul><li>Suspected diagnosis by history and physical examination </li></ul><ul><li>Supported by investigations <...

Plain X-ray (Most valuable) <ul><li>sclerotic </li></ul><ul><li>Lytic </li></ul>Mixed (most common)

Plain X-ray <ul><li>Lesions are usually permeative </li></ul><ul><li>Associated with destruction of the cancellous and cor...

Plain X-ray <ul><li>Periosteal reaction may appear as the characteristic Codman triangle. </li></ul><ul><li>Extension of...

Other investigations <ul><li>MRI </li></ul><ul><li>CT </li></ul><ul><li>Angiogram </li></ul><ul><li>Bone scan </li></ul><u...

MRI <ul><li>best to detect extent into bone and soft tissues </li></ul>

CT <ul><li>Not of much use </li></ul><ul><li>CT chest to detect lung metastasis </li></ul>

Angiogram <ul><li>Determine vascularity of the tumour </li></ul><ul><li>Detect vascular displacement </li></ul><ul><li>Rel...

Bone scan <ul><li>A bone scan should be obtained </li></ul><ul><li>to look for skeletal metastases </li></ul><ul><li>or ...

laboratory studies <ul><li>Full blood count, ESR, CRP. </li></ul><ul><li>LDH (elevated level is associated with poor p...

Biopsy <ul><li>to conform the diagnosis. </li></ul><ul><li>Types </li></ul><ul><li>Fine needle aspiration </li></ul><ul><...

Enneking staging system <ul><li>The staging system is typically depicted as follows </li></ul><ul><li>Stage I: Low grade t...

Differential Dx <ul><li>Giant Cell Tumor </li></ul><ul><li>Chondrosarcoma </li></ul><ul><li>Fibrosarcoma </li></ul><ul><li...

Surface osteosarcoma <ul><li>Parosteal </li></ul><ul><li>Periosteal </li></ul><ul><li>High grade surface osteosarcoma </li...

Parosteal <ul><li>5% of osteosarcomas </li></ul><ul><li>Posterior metaphysis of </li></ul><ul><li>distal femur </li></ul><...

Periosteal <ul><li>Arises from surface of diaphysis </li></ul><ul><li>Most commonly femur and tibia </li></ul><ul><li>Cha...

High grade surface <ul><li>Very rare </li></ul><ul><li>Age group 20-30’s </li></ul><ul><li>Appearance as parosteal but his...

$Telangiectatic Osteosarcoma <ul><li>Aggressive </li></ul><ul><li>Presents with pathological fracture </li></ul><ul><li>5...$

Prognostic Factors <ul><li>Extent of the disease </li></ul><ul><ul><li>Pts with pulmonary, non pulmonry (bone) or skip m...

Treatment <ul><li>Current standard of care </li></ul><ul><li> Radiological staging </li></ul><ul><li>Biopsy to confirm d...

Chemotherapy <ul><li>Chemotherapy given preoperatively - Neoadjuvant </li></ul><ul><li>Given postoperatively - Adjuvant ...

Chemotherapy <ul><li>The drugs used most often to treat osteosarcoma are: </li></ul><ul><li>Methotrexate with leucovorin (...

Surgery <ul><li>The main goal of surgery is to safely and completely remove the tumor. </li></ul><ul><li>Historically – ...

Surgery choice <ul><li>Surgical procedures fall into three basic categories: </li></ul><ul><li>Amputation </li></ul><ul><...

Decision ??? <ul><li>If the tumor can be removed safely while retaining a viable extremity, a limb sparing procedure may b...

Amputation <ul><li>Amputation involves removal of the limb with a safe margin between the end of </li></ul><ul><li>the re...

$Amputation <ul><li>Indication </li></ul><ul><ul><li>1. Grossly displaced pathologic fracture </li></ul></ul><ul><ul><li>...$

Limb salvage surgery <ul><li>Removing the tumor with a normal cuff of tissue surrounding it while preserving vascular and ...

<ul><li>The skeletal defect must be reconstructed by </li></ul><ul><li>Endoprosthesis (most common) – </li></ul><ul><li>r...

Rotationplasty <ul><li>compromise between amputation and limb salvage </li></ul><ul><li>most commonly used for osteosarcom...

<ul><li>For functional purposes, the distal segment is turned 180 degrees so that the ankle joint functions as a knee join...

Radiotherapy <ul><li>Radiation therapy has no major role in osteosarcoma </li></ul><ul><li>Radiation therapy may be useful...

Follow up and Prognosis <ul><li>Signs of recurrence, metastasis and treatment related complications </li></ul><ul><li>Phys...

<ul><li>THANK YOU ! </li></ul>