Telangiectatic Osteosarcoma

Background

Osteosarcoma is a most common, highly malignant bone tumor affecting children and adolescents in their early ages but it may occur in late ages after an initial bone disease such as Paget Disease . There are two types of osteosarcoma

1. primary osteosarcoma
2. Secondary osteosarcoma

Telangiectatic osteosarcoma. It is  least common variant of osteosarcoma. This tumor mainly occur in metaphyseal region within the medullary cavity of long bones. It is characterized by blood filled vascular spaces lined by osteoblast cells. These osteoblast seperated by fibrus septa which contain malignant cells , multinucleated joint cells and tumor osteiod .

These tumor grown within the medullary cavity and break the cortex which results in fractures however extra osseous masses may be found. Prognosis is very poor and male to female ratio is 2:1 .

Case study 

18 year old male presented to orthopeadic OPD of THQ Wazirabad with chief complaint of pain and swelling in his right knee since last one and half year. Pain was worse at night and showed little relief with NSAIDS . On further questioning it was revealed that he often feels no hunger and a significant weight loss .

On his objective examination it was noted that his knee was swollen , red and tender. His knee was painfull during examination.

Investigations.

• Digital  x ray right knee joint shows a lytic lesion on his right fibula which was extensive with soft tissue involvement
• A CBC was performed to see any sign of infection probably osteomylitis or septic Arthritis
• serum calcium , vit D levels , serum phosphorus, alkaline phosphatse and TSH were investigated to find out other related bone Diseases
• MRI right knee joint shows signal intensity suggestive of cancerous growth.
• A biopsy was planed to further support the initial diagnosis, During biopsy , there was a blood filled mass which was excised along with head of fibula.Biopsy reports confirms the initial diagnosis of Telangiectatic osteosarcoma..
• later a bone scan was performed to see any metastasis.
• patient then reffered to Shoukat khanum for further management.