Objective: To investigate the clinical, imaging, histological, and molecular features and the differential diagnosis of radiation-associated sarcomas of bone and soft tissue. Methods: Forty-six cases of radiation-associated sarcomas of the bone and soft tissue in Beijing Jishuitan Hospital from January 2010 to January 2022 were retrospectively analyzed; and the imaging, histological features and immunophenotype were examined. Results: There were 33 females and 13 males, aged from 18 to 74 years, with a mean of 52 years. The most common site of radiation-associated sarcomas were the limbs and spine (15 cases), followed by the chest (9 cases). The primary diseases included epithelial tumors (15 breast cancer, 6 cervical cancer, and 5 bowel cancer), hematolymphoid tumors, bone and soft tissue tumors and infectious lesions. The latent period of radiation-associated sarcomas ranged from 2-22 years, with an average of 11.6 years. Histopathologically, the morphology was divergent from the primary tumor. The most common malignant tumor type was undifferentiated sarcoma (22 cases), followed by osteosarcoma (16 cases). The immunophenotype of radiation-related sarcoma was almost the same as the corresponding soft tissue sarcoma. Conclusions: Radiation-induced sarcoma has a wide range of primary tumor types and its imaging, morphology and immunohistochemical features are similar to those of the primary sarcoma of bone and soft tissue. Clinical correlation is often recommended for the differential diagnosis.
Male ; Female ; Humans ; Retrospective Studies ; Sarcoma/pathology* ; Osteosarcoma/diagnostic imaging* ; Soft Tissue Neoplasms/pathology* ; Bone Neoplasms/pathology*

BACKGROUND: We assessed the plain radiographic characteristics of 10 cases of osteosarcomas during the initial painful period that had been overlooked by a primary physician. In addition, we evaluated chronologic changes in radiographic findings from initial symptomatic period to the time of accurate diagnosis. METHODS: The clinical records were reviewed for clinical parameters including age, sex, location, presenting symptoms, initial diagnosis, duration from initial symptoms to definite diagnosis, and initial and follow-up plain radiographic findings of the lesion. RESULTS: Initial clinical diagnoses included a sprain in 6, growing pain in 2, stress fracture in 1, and infection in 1 patient. Initial plain radiographic findings were trabecular destruction (100%), cortical disruption (60%), periosteal reaction (60%), and soft tissue mass (10%). Intramedullary matrix changes were osteosclerosis in 6 and osteolysis in 4 patients. On progression, 4 cases with minimal sclerosis changed to osteoblastic lesion in 3 patients and osteolytic lesion in 1. Four cases with faint osteolytic foci transformed into osteolytic lesion in 3 and mixed pattern in 1. CONCLUSIONS: Notable plain radiologic findings of incipient-stage osteosarcoma include trabecular disruption along with faint osteosclerosis or osteolysis. In symptomatic patients with trabecular destruction, additional imaging study including magnetic resonance imaging should be performed to exclude osteosarcoma in the incipient phase, even without radiologic findings suggesting malignant tumor, such as cortical destruction or periosteal reaction.
Adolescent ; Adult ; Age Factors ; Bone Neoplasms/diagnosis/*radiography ; *Diagnostic Errors ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Osteosarcoma/diagnosis/*radiography ; Retrospective Studies ; Young Adult

PURPOSE: Various diagnostic imaging modalities have been used to evaluate the effect of neoadjuvant chemotherapy for osteosarcoma early and noninvasively. We evaluated the effectiveness of imaging studies of plain radiographs and positron-emission tomography/computed tomography (PET/CT) in predicting neoadjuvant chemotherapy effect for osteosarcoma and tried to establish a general principle in interpretation of PET/CT parameters. MATERIALS AND METHODS: Eighteen patients who underwent two cycles of neoadjuvant chemotherapy and surgical excision for osteosarcoma were enrolled. There were 13 males and 5 females, with a median age of 19 (11-63) years. Fifteen patients of 18 had the American Joint Committe on Cancer (AJCC) stage IIB. They had plain radiographs and PET/CT before and after neoadjuvant chemotherapy. The resected tumor specimens were pathologically examined to determine histological response grade using a conventional mapping method. Statistical analysis was performed to evaluate the correlation between histopathological necrosis rate, and radiographic finding category, post-chemotherapy maximum standardized uptake value (SUVmax), average standardized uptake value and metabolic tumor volume (MTV) as well as reduction rates of them. RESULTS: Eight patients were good responders to neoadjuvant chemotherapy based on histological evaluation. Median SUVmax reduction rate was 73 (23-77) % in good responders and 42 (-32-76) % in poor responders. Median MTV reduction rate was 93.5 (62-99) % in good responders and 46 (-81-100) % in poor responders. While radiographic finding category was not different according to histological response (p=1.0), SUVmax reduction rate was significantly different (p=0.041). Difference in MTV reduction rates approached statistical significance as well (p=0.071). CONCLUSION: While radiographic finding category was not reliable to assess neoadjuvant chemotherapy effect for osteosarcoma, reduction rate of SUVmax was a useful indicator in this study. As parameters of PET/CT can be influenced by various factors of settings, different centers have to make an effort to establish their own standard of judgement with reference of previous studies.
Diagnostic Imaging ; Drug Therapy* ; Female ; Humans ; Joints ; Male ; Necrosis ; Neoadjuvant Therapy ; Osteosarcoma* ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Tumor Burden

Humans ; Male ; Osteosarcoma ; complications ; diagnostic imaging ; surgery ; Ultrasonography ; Wounds and Injuries ; complications ; Young Adult

Breast metastases are uncommon and typically spread from contralateral breast carcinomas. Breast metastases that spread from extramammary malignancies are even less common, and account for 0.5%-6.6% of all malignant breast disease. As extrapulmonary metastases from osteosarcoma are uncommon, breast metastasis from osteosarcoma is extremely rare. We report a case of breast and peritoneal metastases from a tibial osteosarcoma 18 months after diagnosis, and 9 months after surgery and adjuvant chemotherapy. Computed tomography findings of multiple calcified and noncalcified tumour deposits in the lungs, pleura, peritoneum, chest wall and both breasts are described.
Adolescent ; Bone Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Breast Neoplasms ; diagnostic imaging ; secondary ; Female ; Humans ; Neoplasm Metastasis ; Osteosarcoma ; diagnosis ; diagnostic imaging ; pathology ; Peritoneal Neoplasms ; diagnostic imaging ; secondary ; Tomography, X-Ray Computed

OBJECTIVETo study the histogenesis of giant cell tumor (GCT) and factors related to tumor recurrence, invasiveness and malignant transformation.

METHODSThe clinical features, radiologic classification, surgical approach, pathologic findings, immunophenotypes and follow-up data of 123 cases of GCT were analyzed.

RESULTSThere was a significant correlation between tumor recurrence and radiographic classification (P = 0.032), over-expression of CD147 (P = 0.034) and p53 (P = 0.005), and surgical approach (P = 0.0048) in GCT. The biologic behavior showed no correlation with intramedullary infiltration, cortical bone involvement, parosteal soft tissue extension, tumor thrombi, fusiform changes of mononuclear tumor cells, mitotic count, Ki-67 index, coagulative tumor necrosis, secondary aneurysmal bone cyst formation, and adjoining bony reaction. The positive rate of p63 in stromal cells of GCT (79.7%, 94/118) was significantly higher than that in chondroblastoma (44.7%, 21/47), osteosarcoma (22.2%, 10/45) and other giant cell-rich tumors.

CONCLUSIONSGCT is a bone tumor of low malignant potential. It is sometimes characterized by locally invasive growth, active proliferation, coagulative necrosis, secondary aneurysmal bone cyst and surrounding bony reaction. It is difficult to predict the biologic behavior of GCT. Over-expression of p53 in the tumor cells and CD147 in all components of GCT correlate with tumor invasiveness, recurrence and malignant transformation. Selection of suitable surgical approach with reference to radiologic classification is considered as an important factor in reducing the recurrence rate.

Adolescent ; Adult ; Aged ; Basigin ; metabolism ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; surgery ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; surgery ; Humans ; Male ; Membrane Proteins ; metabolism ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Phosphoglucomutase ; metabolism ; Radiography ; Tumor Suppressor Protein p53 ; metabolism ; Young Adult

OBJECTIVETo evaluate the application of ²⁰¹TI and (99m)Tc-MIBI scintigraphy in assessment of neoadjuvant chemotherapy for osteosarcoma.

METHODSTwenty-two patients with osteosarcoma underwent both ²⁰¹TI and (99m)Tc-MIBI scintigraphy. According to tumor necrosis rate (TNR), 22 patients were classified into three groups: Group 1(necrosis less than 50%), Group 2(50% ≊ 89% necrosis) and Group 3(necrosis greater than 90%). The uptake ratio(UR) was obtained in images before and after chemotherapy. The alteration ratio(AR) and tumor necrosis ratio (TNR) were calculated.

RESULTSIn ²⁰¹Tl images,UR(pre) and UR(post) (mean ± s.d.) of Group 1 were 2.14 ± 0.67, 2.07 ± 0.71 (P>0.05); UR(pre) and UR(post)of Group 2 were 3.45 ± 1.57 and 2.02 ± 0.97 (P<0.01); UR(pre) and UR(post) of Group 3 were 3.57 ± 0.67 and 1.36 ± 0.20 (P<0.01). In (99m)Tc-MIBI images, UR(pre)and UR(post) of Group 1 were 1.66 ± 0.42 and 1.85 ± 0.70 (P>0.05); UR(pre) and UR(post) of Group 2 were 2.39 ± 1.41 and 1.68 ± 0.72 (P<0.05);UR(pre) and UR(post) of Group 3 were 2.56 ± 0.60 and 1.19 ± 0.14 (P<0.01). The AR value in (201)Tl scintigraphy was -0.03-0.72, the liner regression analysis of AR versus TNR showed a highly significant positive correlation (r=0.95). The AR value in (99m)Tc-MIBI scintigraphy was -1.21-0.64, the liner regression analysis of AR versus TNR showed a highly significant positive correlation (r=0.71). The liner regression analysis of AR in ²⁰¹TI scintigraphy versus AR in (99m)Tc-MIBI scintigraphy showed a highly significant positive correlation (r=0.70).

CONCLUSIONThe AR changes significantly after neoadjuvant chemotherapy and is positively correlated with TNR, which indicates that ²⁰¹TI- and (99m)Tc-MIBI scintigraphy can be used for evaluation of neoadjuvant chemotherapy.

Adolescent ; Adult ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; Child ; Female ; Humans ; Male ; Neoadjuvant Therapy ; Osteosarcoma ; diagnostic imaging ; drug therapy ; Preoperative Care ; Radionuclide Imaging ; Technetium Tc 99m Sestamibi ; Thallium Radioisotopes ; Young Adult

Adult ; Chemotherapy, Adjuvant ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms ; secondary ; Mediastinal Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Mediastinum ; diagnostic imaging ; pathology ; Neoplasm Recurrence, Local ; Osteosarcoma ; diagnostic imaging ; drug therapy ; pathology ; secondary ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo study the clinical manifestations, radiologic findings, pathologic diagnosis and differential diagnosis of primary osteosarcoma in elderly patients.

METHODSTwelve cases of primary osteosarcoma occurring in patients older than 60 years were encountered during the period from 1985 to 2010. The clinical manifestations, radiologic features and pathologic findings were studied and the follow-up data were analyzed.

RESULTSThe sites of involvement included long bones (number = 7), ilium (number = 1), craniofacial bones (number = 2) and soft tissue (number = 2). Radiologic examination showed a mixture of osteosclerotic and osteolytic lesions in 10 patients, soft tissue lesions with high-density areas in 2 patients and soft tissue lesions with periosteal reaction in 8 patients. Histologically, most cases showed features of conventional osteosarcoma. There were 2 cases of malignant fibrous histiocytoma-like osteosarcoma, 2 cases of chondroblastic osteosarcoma and 1 case of well-differentiated intraosseous osteosarcoma. Immunohistochemical study played little role in pathologic diagnosis. Ten patients had undergone amputation, including one patient who had received adjuvant chemotherapy beforehand. Nine patients had follow-up information available. Three of them died of lung metastasis and 1 died of cardiovascular disease.

CONCLUSIONSPrimary osteosarcoma rarely occurs in elderly patients and can easily be missed. Correlation with clinical, radiologic and histologic features is important for arriving at a correct diagnosis.

12E7 Antigen ; Aged ; Antigens, CD ; metabolism ; Bone Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Cell Adhesion Molecules ; metabolism ; Chondrosarcoma ; pathology ; Diagnosis, Differential ; Female ; Femoral Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Follow-Up Studies ; Humans ; Ilium ; Lung Neoplasms ; secondary ; Lymphoma ; pathology ; Male ; Middle Aged ; Osteitis Deformans ; pathology ; Osteosarcoma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Radiography ; Soft Tissue Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Vimentin ; metabolism

Parosteal osteosarcoma (POS) is the most common form of surface osteosarcoma. Its symptoms are insidious and its duration prior to diagnosis is considerably longer than that of other types of osteosarcoma. We report a case of POS with a growing mass but no evidence of metastasis. This tumor, which was diagnosed as calcified hematoma with benign characteristics, was incompletely resected in our hospital 21 years before the diagnosis of recurrence. The patient underwent a wide en bloc resection in our hospital and was free of symptoms, with no signs of tumor recurrence or metastasis during a 53-month follow-up.
Adult ; Bone Neoplasms ; diagnosis ; pathology ; surgery ; Diagnostic Errors ; Follow-Up Studies ; Humans ; Humerus ; Magnetic Resonance Imaging ; Male ; Neoplasm Recurrence, Local ; Osteosarcoma, Juxtacortical ; diagnosis ; pathology ; surgery ; Radiopharmaceuticals ; Technetium Tc 99m Medronate ; Tomography, Emission-Computed ; Tomography, X-Ray Computed