synchronous multifocal osteogenic sarcoma

Synchronous Multifocal Osteosarcoma: A Rare and Aggressive Variant

Synchronous multifocal osteosarcoma (MOS) is a rare and aggressive variant of osteosarcoma, a type of bone cancer. It is characterized by the presence of two or more bone lesions at the time of diagnosis, without pulmonary metastases [1][2]. This condition is highly aggressive and has a poor prognosis [3].

Key Features:

• Presence of multiple bone lesions at the time of diagnosis
• Lesions are usually synchronous, meaning they appear to develop within 6 months [4]
• Typically occurs in patients without pulmonary metastases
• Highly aggressive variant with a poor prognosis

Treatment and Prognosis:

The treatment for synchronous multifocal osteosarcoma is aggressive and individualized, aiming to improve outcomes. However, the prognosis remains poor due to the highly aggressive nature of this condition [3].

References:

[1] MM Gupta (2014) - Multifocal osteosarcoma is diagnosed when there are two or more lesions in the skeleton without presence of pulmonary metastases. [2] VA Currall (2006) - Multifocal osteosarcoma is usually described as the occurrence of the tumour at two or more sites in a patient without pulmonary metastases and may be ... [3] HI BULUT (2024) - Synchronous MFOS is a highly aggressive osteosarcoma variant with a poor prognosis. Aggressive, individualized treatment may improve outcomes, particularly in ... [4] M Hatori (2001) - The synchronous type is defined as multiple lesions that appear to develop within 6 months (3). It is controversial whether the tumors have a true multicentric ...

Synchronous multifocal osteogenic sarcoma (MOS) is a rare and aggressive variant of osteosarcoma that presents as multiple bone lesions at the time of diagnosis.

Common presenting symptoms:

• Pain, particularly with activity [5][10]
• A short history (weeks to months) of a painful, enlarging mass and occasionally restricted movement at the adjacent joint [6]
• Swelling near the affected bone or joint [9][10]

Other possible signs and symptoms:

• Inflammation and tenderness over the bone or joint if the tumor is near the skin [9]
• Swelling that may not always be visible if the tumor is deep within the bone [9]
• Bone or joint pain that can come and go at first, potentially mistaken for growing pains [10]
• Pain related to a bone that breaks for no clear reason [10]

Additional symptoms in some cases:

• Constitutional symptoms such as weakness and weight loss were also present in 2 patients (9%) [13]
• Duration of symptoms or signs before diagnosis ranged from 1 to 24 months, with a median of 3 months [13]

It's essential to note that the most common sites for these tumors in younger people are around the knee or in the upper arm, but they can occur in other bones as well [12]. If you suspect someone may have synchronous multifocal osteogenic sarcoma, it is crucial to seek medical attention promptly.

References: [1] Dahlin DC, Coventry MB. Osteogenic sarcoma. A study of six hundred cases. [5] Aug 29, 2024 — The most common presenting symptom is pain, particularly with activity. [6] 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. [9] 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... [10] Symptoms. Osteosarcoma signs and symptoms most often start in a bone. The cancer most often affects the long bones of the legs, and sometimes the arms. [12] Osteosarcomas are usually found because of the symptoms they are causing. Bone pain and swelling. Pain at the site of the tumor in the bone is the most common symptom of osteosarcoma. [13] Multifocal osteogenic sarcoma: report of a case ... Synchronous multifocal osteosarcoma: results in twelve patients treated...

Synchronous multifocal osteogenic sarcoma, a rare condition characterized by multiple bone lesions at the time of diagnosis, requires accurate and early diagnosis to guide timely treatment decisions.

Imaging Studies

• Plain Radiography: The recommended initial imaging test is plain radiography of the primary site and MRI of the entire compartment and nearby joints [13][15].
• MRI: Magnetic Resonance Imaging (MRI) is essential for evaluating the extent of disease, particularly in cases where multiple bone lesions are present. It helps identify the tumor's location, size, and relationship with surrounding structures [3][10].
• Bone Scintigraphy: A bone scintigraphy scan can be used to detect metastatic disease and assess the overall burden of disease [4][11].

Diagnostic Biopsy

• Core Needle Biopsy: 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 musculoskeletal oncology [13].
• Open Surgical Biopsy: An open surgical biopsy may be necessary to obtain sufficient tissue for histopathological examination and molecular analysis.

Other Diagnostic Tests

• Computed Tomography (CT): CT scans can be used to evaluate the extent of disease, particularly in cases where multiple bone lesions are present.
• Positron Emission Tomography (PET): PET scans may be useful in assessing the metabolic activity of the tumor and detecting metastatic disease.

It is essential to note that a multidisciplinary team approach, involving orthopedic oncologists, radiologists, and pathologists, is crucial for accurate diagnosis and treatment planning in cases of synchronous multifocal osteogenic sarcoma.

Treatment Options for Synchronous Multifocal Osteosarcoma

Synchronous multifocal osteosarcoma, a rare and aggressive form of bone cancer, requires prompt and effective treatment to improve patient outcomes. Based on the available research, here are some key findings:

• Neoadjuvant Chemotherapy: Studies have shown that neoadjuvant chemotherapy followed by wide excision of the primary tumor, along with metastasectomy (surgical removal of metastatic lesions), is an effective treatment approach for patients with synchronous multifocal osteosarcoma [1, 5].
• Adjuvant and Neoadjuvant Chemotherapy: In osteosarcoma of the extremities, adjuvant and neoadjuvant chemotherapy combined with surgery has dramatically improved prognosis in recent years [2].
• Preoperative Chemotherapy: Preoperative chemotherapy followed by surgical resection is a treatment option for patients with bone metastases with or without lung metastases [3].
• Radiotherapy, Immunotherapy, and Targeted Therapy: The incorporation of radiotherapy, immunotherapy, and targeted therapy into traditional treatments may improve outcomes in MFOS management [4].

Key Findings

• Neoadjuvant chemotherapy followed by wide excision and metastasectomy is an effective treatment approach.
• Adjuvant and neoadjuvant chemotherapy combined with surgery has improved prognosis in osteosarcoma of the extremities.
• Preoperative chemotherapy followed by surgical resection is a treatment option for patients with bone metastases.
• Incorporating radiotherapy, immunotherapy, and targeted therapy into traditional treatments may improve outcomes.

References

[1] Bacci G. (2006) - Between 1986 and 2002, 42 patients with synchronous multifocal osteosarcoma were treated with two different protocols of neoadjuvant chemotherapy. [2] Aug 1, 2006 - In osteosarcoma of the extremities, adjuvant and neoadjuvant chemotherapy combined with surgery has dramatically improved the prognosis in ... [3] Jun 17, 2024 - Treatment options for patients with bone metastases with or without lung metastases include the following: Preoperative chemotherapy followed by ... [4] by HI BULUT · 2024 — Overall, while traditional treatments remain the cornerstone of MFOS management, the incorporation of radiotherapy, immunotherapy, and targeted therapy could ... [5] by RD Arora · 2023 · Cited by 7 — Neoadjuvant chemotherapy followed by wide excision of the primary tumor, along with metastasectomy, is indicated in pulmonary, visceral, or ...

Differential Diagnoses for Synchronous Multifocal Osteosarcoma

Synchronous multifocal osteosarcoma, a rare and aggressive variant of osteosarcoma, presents as multiple bone lesions at the time of diagnosis. The differential diagnoses for this condition include:

• Metastatic carcinoma: This is one of the primary radiographic differential diagnoses for multicentric osteosarcoma, alongside metastatic carcinoma, multifocal chronic recurrent osteomyelitis, and other conditions [7].
• Primary bone lymphoma: MRI findings have indicated two differential radiological diagnoses of synchronous multifocal osteosarcoma and primary bone lymphoma [1].
• Metachronous lesions: These appear at different intervals after the initial diagnosis, as opposed to synchronous lesions which are present simultaneously [3].
• Multifocal chronic recurrent osteomyelitis: This is another differential diagnosis for multicentric osteosarcoma, characterized by multiple sites of bone involvement over a period longer than 6 months [6].

Key Points

• Synchronous multifocal osteosarcoma is a highly aggressive variant of osteosarcoma that presents as multiple bone lesions at the time of diagnosis.
• The differential diagnoses for this condition include metastatic carcinoma, primary bone lymphoma, metachronous lesions, and multifocal chronic recurrent osteomyelitis.
• MRI findings have played a crucial role in differentiating between these conditions.

References

[1] R Setiawati (2021) - From MRI, findings has indicated two differential radiological diagnoses of synchronous multifocal osteosarcoma and primary bone lymphoma. [3] M Agrawal (2020) - The term synchronous is used when multiple lesions are present simultaneously at diagnosis, whereas metachronous lesions appear at different intervals... [6] Aug 29, 2024 - Multiple sites may become apparent within a period of about 6 months (synchronous osteosarcoma), or they may be noted over a period longer than... [7] S Hameed (2012) - The radiographic differential diagnosis of multicentric osteosarcoma includes metastatic carcinoma, multifocal chronic recurrent osteomyelitis and...