A 16 year old boy with Osteosarcoma of Tibia Neoadjuvant chemotherapy Surgery: Wide Resection and Megaprosthesis Joint Replacement Surgery Adjuvant chemotherapy
Osteosarcoma is the malignant bone tumor that arises from primitive mesenchymal bone-forming cells, and its histologic hallmark is the production of malignant osteoid. Each year in the United States, about 400 children and teens younger than age 20 are diagnosed with osteosarcoma. Osteosarcoma is the third most common cancer in children, after lymphomas and brain tumors. It often starts in the ends of the bones where new bone tissue forms as a young person grows. Bones in the thigh, upper arm, and leg are the most common sites. The cause of osteosarcoma is unknown and only rarely does osteosarcoma run in families. Children with retinoblastoma have a high risk for osteosarcoma in adolescence.
Pain and swelling in the affected bone is the most common symptom. Pain is severe in nature and associated with limitation of movement of affected joint. Initially there is small swelling and increases rapidly to bigger size. On clinical examination of swelling, local warmth with dilation of veins in the over lying area can be observed. Occasionally patients present with pathological fracture due to trivial trauma.
Plain radiograph of the affected bone with adjacent joint is obtained with chest radiograph. The radiological findings of osteosarcoma shows a lytic/sclerotic /mixed lesion with wide zone of transition, sun ray type of periosteal reaction and soft tissue swelling. Magnetic resonance imaging (M.R.I.) is performed to visualize the extent of tumor and relationship with neurovascular structures, followed by J needle biopsy to obtain histopathological diagnosis. Staging investigations consist of Computed Tomography of chest and Bone scan or PET-CT scan.
Limb salvage surgery for bone tumors in the immature skeleton creates unique problems. When the estimated leg-length discrepancy at skeletal maturity is more than 3 cm or when the arm-length discrepancy is more than 5 cm expandable, Megaprosthesis is performed. The minimally invasive and noninvasive types of expandable prosthesis are used. Every six monthly the limb is expanded as compared with opposite limb until skeletal maturity is achieved.
Dr. Abhijeet Ashok Salunke
Consultant – Orthopedic Oncosurgeon
Shalby Hospitals, Ahmedabad
For More Details +91 98240 99953