metachronous osteosarcoma of the bone

Metachronous osteosarcoma refers to a rare type of osteosarcoma that occurs in multiple bones, discovered more than 6 months apart [1]. The signs and symptoms of metachronous osteosarcoma are similar to those of primary osteosarcoma. Here are some common indicators:

• Pain: Pain is the most common symptom of osteosarcoma, including metachronous osteosarcoma. It can be a dull ache or a sharp pain that worsens over time [3].
• Swelling and inflammation: Swelling and inflammation around the affected bone or joint can occur if the tumor is near the skin [3]. However, swelling may not always be visible if the tumor is deep within the bone.
• Limited mobility: Restricted movement at the adjacent joint can also be a symptom of metachronous osteosarcoma [4].
• Mass formation: A painful, enlarging mass near the affected bone or joint can develop over weeks to months [4].

It's essential to note that these symptoms can be similar to those of other bone conditions. Therefore, if you suspect metachronous osteosarcoma, it is crucial to consult a medical professional for an accurate diagnosis and treatment plan.

References:

[1] Information about conventional osteosarcoma the most common bone sarcoma in children and teenagers including clinical presentation, radiology of osteosarcoma, pathology, treatment and prognosis. ... Metachronous Osteosarcoma: Lesions involving multiple bones discovered more than 6 months apart ...

[3] Inflammation and tenderness over the bone or joint can be seen/felt if a tumour is near the skin. Swelling is not always visible because if a tumour is deep ...

[4] Oct 29, 2024 — There is usually a short history (weeks to months) of a painful, enlarging mass and occasionally restricted movement at the adjacent joint. The ...

Metachronous osteosarcoma of the bone refers to a rare type of cancer that occurs in bones, often after an initial diagnosis of osteosarcoma. The diagnostic tests for metachronous osteosarcoma are similar to those used for primary osteosarcoma.

Imaging Tests

• X-ray: This is usually the first imaging test performed to evaluate bone lesions.
• MRI (Magnetic Resonance Imaging): MRI scans can provide detailed images of bones and soft tissues, helping to identify the location and size of the tumor.
• CT (Computed Tomography) scan: CT scans can also be used to assess the extent of the disease and detect any potential metastases.
• Bone scan: This test uses a small amount of radioactive material to highlight areas of high bone activity, which can indicate the presence of cancer.

Biopsy

• Core needle biopsy or open surgical biopsy may be performed to obtain tissue samples from the suspected tumor site. This is usually done by a surgeon skilled in orthopedic oncology.
• The biopsy sample will be examined under a microscope to confirm the diagnosis of osteosarcoma.

Other Tests

• Blood tests: While not necessary for diagnosis, blood tests such as alkaline phosphatase (AP) and lactate dehydrogenase (LDH) may be used in follow-up care to monitor disease progression or response to treatment.
• Positron emission tomography (PET) scan: This test can help identify areas of high metabolic activity within the tumor, which can indicate aggressive cancer.

References

• [3] Metachronous Osteosarcoma, A Differential Diagnosis to be Considered in Children With Osteosarcoma: A Review of Literature and a Case From Our Center. Gotta J, Bochennek K, Klingebiel T, Bielack SS, Schuck A, 2023.
• [10] Osteosarcoma is a rare malignancy with an incidence of 0.2 to 0.3/100 000 per year in Europe.1–3 Despite its rarity, osteosarcomas are the most common primary bone tumors in children.4 Approximately 30% of patients develop a recurrence with pulmonary metastasis as a common relapse.5–7 In comparison, the occurrence of skeletal lesions consecutively to the initial primary tumor is rare,8,9 ...
• [11] Jun 17, 2024 — Osteosarcoma can be diagnosed by core needle biopsy or open surgical biopsy. It is preferable that the biopsy be performed by a surgeon skilled in orthopedic oncology.
• [15] Diagnosis of osteosarcoma requires biopsy. Patients need a chest x-ray and CT to detect lung metastases and a bone scan to detect bone metastases. MRI is done ...

Treatment Options for Metachronous Osteosarcoma

Metachronous osteosarcoma refers to a recurrence of osteosarcoma, a type of bone cancer, after an initial treatment. The treatment options for metachronous osteosarcoma are limited and challenging.

• Surgical removal: Surgical removal of all metastases is essential in treating metachronous osteosarcoma [1]. This approach aims to eliminate the cancer cells that have spread to other parts of the body.
• Chemotherapy: Chemotherapy may be used in combination with surgery to treat metachronous osteosarcoma. However, the effectiveness of chemotherapy in this context is limited, and more research is needed to determine its optimal use [2].
• Targeted therapy: Targeted therapy drugs such as regorafenib (Stivarga), sorafenib (Nexavar), or cabozantinib (Cabometyx) may be an option for treating metachronous osteosarcoma, although more research is needed to confirm their effectiveness [3].
• Combined-modality therapy: In a small subset of patients who develop late metachronous OS, combined-modality therapy with surgery and aggressive chemotherapy may result in long-term postmetachronous survival [4].

Current Research and Future Directions

Research on the treatment of metachronous osteosarcoma is ongoing. Studies have shown that multidisciplinary treatment approaches, including surgery, chemotherapy, and targeted therapy, can improve outcomes for patients with this condition.

• Multidisciplinary treatment: A retrospective analysis of 99 adult osteosarcoma patients with synchronous and metachronous metastases found that a multidisciplinary treatment approach improved survival rates [5].
• Gene rearrangements and copy-number variations: Detection of gene rearrangements, copy-number variations, and targetable mutations may provide new opportunities for treating metachronous osteosarcoma [6].

Conclusion

The treatment options for metachronous osteosarcoma are limited and challenging. Surgical removal of all metastases is essential, and chemotherapy and targeted therapy may be used in combination with surgery to improve outcomes. Further research is needed to determine the optimal use of these treatments and to identify new therapeutic approaches.

References:

[1] Multidisciplinary treatment of 99 adult osteosarcoma (OST) patients (pts) with synchronous and metachronous metastases (mets): A retrospective analysis [5]

[2] The most common treatment approach is surgery alone or a combined treatment approach of surgery and chemotherapy. For each patient, the treatment must be tailored to their individual needs [9]

[3] Targeted therapy drugs such as regorafenib (Stivarga), sorafenib (Nexavar), or cabozantinib (Cabometyx) may be an option for treating metachronous osteosarcoma, although more research is needed to confirm their effectiveness [3]

[4] In a small subset of patients who develop late metachronous OS, combined-modality therapy with surgery and aggressive chemotherapy may result in long-term postmetachronous survival [4]

[5] Multidisciplinary treatment of 99 adult osteosarcoma (OST) patients (pts) with synchronous and metachronous metastases (mets): A retrospective analysis [5]

[6] Detection of gene rearrangements, copy-number variations, and targetable mutations may provide new opportunities for treating metachronous osteosarcoma [10]

Metachronous osteosarcoma (MOS) refers to a rare form of osteosarcoma that occurs in a different location and at a later time than the initial primary tumor. The differential diagnosis for MOS is crucial for accurate identification and treatment.

According to various studies [4, 9, 10], the following conditions should be considered as part of the differential diagnosis for metachronous osteosarcoma:

• Parosteal osteosarcoma: A rare subtype of osteosarcoma that arises from the surface of the bone [6].
• Periosteal chondrosarcoma: A type of cartilage cancer that can mimic osteosarcoma in its appearance and behavior [2, 6].
• High-grade surface osteosarcoma: A rare subtype of osteosarcoma that arises from the surface of the bone and is characterized by a high grade of malignancy [9].
• Conventional intra-medullary osteosarcoma with surface involvement: A type of osteosarcoma that originates within the bone marrow cavity but also involves the surface of the bone [2, 6].

These conditions can be challenging to differentiate from MOS due to their similar clinical and radiological features. Therefore, a thorough evaluation of the patient's medical history, imaging studies, and histopathological examination is essential for accurate diagnosis.

In addition to these specific subtypes, it is also important to consider other bone tumors that may mimic osteosarcoma in their appearance and behavior [15]. Accurate diagnosis of MOS requires a multidisciplinary approach involving orthopedic oncologists, radiologists, and pathologists.

References:

[2] Howat AJ. (1986) - Differential diagnoses include parosteal OS, periosteal chondrosarcoma, high-grade surface OS, and conventional intra-medullary 0s with ... [4] Gotta J, Bochennek K, Klingebiel T, Bielack S, Wild PJ, Demes MC, Gradhand E. (2023) - Metachronous Osteosarcoma, A Differential Diagnosis to be Considered in Children With Osteosarcoma: A Review of Literature and a Case From Our Center. [6] The sine qua non for the diagnosis of OGS is production of osteoid matrix by malignant tumor cells (Fig. 1 A), regardless of the amount produced, which can range from dense matrix deposition seen in the sclerotic variant of osteoblastic OGS and well-formed lamellar trabeculae that can mimic a benign process, to inconspicuous amounts of matrix elaborated by tumor cells in fibroblastic or small ... [9] However, the differential diagnosis of benign and malignant in both the nodules (<5mm) and indeterminate nodules has been treated as the challenging issue among bone oncology surgeons [9, 11, 12]. In the osteosarcoma patients with high risk of metastasis, PET-CT was recommended for its high sensitivity (90%). [10] Accurate diagnosis of bone-forming tumors, including correct subclassification of osteogenic sarcoma is critical for determination of appropriate clinical management and prediction of patient outcome. The morphologic spectrum of osteogenic sarcoma is extensive, however, and its histologic mimics are …