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Pediatric Osteosarcoma


Presentation

  • CONCLUSION: Osteosarcoma complicated by pathological fracture as first presentation had higher incidence of lung and bone metastases at presentation and worse survival rate when compared with patients without pathological fracture.[read.qxmd.com]
  • Around 32% of patients had stage IV disease at presentation. Around 37% of patients from rural areas and 20% of patients from urban areas presented with metastatic disease.[ijmrhs.com]
  • Calcaneal osteosarcoma usually has a nonspecific presentation such as pain and tenderness in the heel. Swelling can also be one of the presentations.[ojionline.org]
  • Clinical Presentation The presenting symptoms of cranial osteosarcoma vary based on the anatomical site of the lesion. 59 Like osteosarcoma of the long bones, craniofacial osteosarcomas often present as slow-growing masses. 51 Unlike long bone lesions[thejns.org]
  • Case Presentation An 8-year-old African American male presented with his mother to Nova Southeastern University Department of Oral and Maxillofacial Surgery with a history of diffuse swelling above his upper right front teeth consistently for two months[clinicsinsurgery.com]
Asymptomatic
  • The patient reported that he was asymptomatic with no pain, no numbness, nor any history of fever, loss of appetite, weight loss, epistaxis, nasal obstruction, or change in vision. There was no contributory medical, social or family history.[clinicsinsurgery.com]
  • As pain progressively worsens, the affected area becomes tender and swells to the point of functional limitation. 1 An estimated 5% to 10% of patients are asymptomatic until a pathologic fracture reveals an underlying osteosarcoma. 2, 5 Serum alkaline[journals.sagepub.com]
  • The patient was asymptomatic. The lesion was resected en bloc, including a 1-cm margin of normal-appearing bone circumferentially. The dura and scalp appeared normal. Pathological analysis confirmed metastatic osteoblastic osteosarcoma.[thejns.org]
Constitutional Symptom
  • He denied constitutional symptoms and was neurologically intact on examination. The patient reported a history of trauma 5 years earlier when he was hit in the head with a baseball bat in the same location.[thejns.org]
Pneumonia
  • Among the 42 pulmonary nodules, 24 were pulmonary metastases and 18 were non-metastatic pulmonary nodules (12 intrapulmonary lymph nodes, 4 non-neoplastic lung parenchyma, 1 organizing pneumonia, and 1 atypical adenomatous hyperplasia).[journals.plos.org]
Anosmia
  • He had persistent visual loss in the left eye and anosmia, but no evidence of pituitary insufficiency or progressive neurological deficit.[thejns.org]
Loss of Appetite
  • The patient reported that he was asymptomatic with no pain, no numbness, nor any history of fever, loss of appetite, weight loss, epistaxis, nasal obstruction, or change in vision. There was no contributory medical, social or family history.[clinicsinsurgery.com]
Thrombosis
  • Keywords : Osteosarcoma; metastasis; venous thrombosis.[scielo.sa.cr]
Heel Pain
  • Keywords: Calcaneal osteosarcoma, heel pain, misdiagnosis, osteoid, pediatric How to cite this article: Sarangi PK, Kumar ES, Mohanty J. Calcaneal osteosarcoma: An unusual cause of chronic pediatric heel pain.[ojionline.org]
Skull Mass
  • masses in children are dermoid cysts and Langerhans cell histiocytosis, which may be difficult to distinguish from malignant tumors such as osteosarcoma or Ewing sarcoma. 25 Although the lytic and sclerotic radiological pattern is highly suggestive of[thejns.org]
Eye Pain
  • Case 3 A 14-year-old-boy presented to an outside hospital with left eye pain, periorbital swelling, blurred vision, and significant epistaxis.[thejns.org]
Blurred Vision
  • Case 3 A 14-year-old-boy presented to an outside hospital with left eye pain, periorbital swelling, blurred vision, and significant epistaxis.[thejns.org]
Visual Impairment
  • impairment. 22, 51 Elevation of the serum alkaline phosphatase level is common, although not uniformly observed. 59 Imaging with MRI and CT may reveal bone growth with lytic regions and periosteal remodeling, as seen in osteosarcomas of other areas.[thejns.org]
Epistaxis
  • He was taken to the operating room for control of epistaxis. Endonasal biopsy revealed chondroblastic osteosarcoma.[thejns.org]
  • The patient reported that he was asymptomatic with no pain, no numbness, nor any history of fever, loss of appetite, weight loss, epistaxis, nasal obstruction, or change in vision. There was no contributory medical, social or family history.[clinicsinsurgery.com]
Paresthesia
  • These patients generally present with symptoms of swelling and a mass of short duration, although dental problems and paresthesia have also been observed.[clinicsinsurgery.com]

Workup

  • Further workup showed no distant metastasis. She underwent below knee amputation and completed four cycles of adjuvant chemotherapy with cisplatin, doxorubicin, and methotrexate.[ojionline.org]
  • Further workup demonstrated a large calcified eroding mass of the skull base, extending into the nasopharynx, left maxillary sinus, ethmoidal sinuses, and sphenoid sinus and along the midline of the anterior skull base to involve the sella turcica and[thejns.org]
  • Initial metastatic workup for all patients included computed tomography scan of the chest and bone scan.[ascopubs.org]
  • Physical examination usually reveals a soft-tissue mass at the primary tumor site, and laboratory workup is seldom remarkable except for elevations of alkaline phosphatase and lactate dehydrogenase, which have been reported with prognostic significance[ncbi.nlm.nih.gov]
Increased Bone Density
  • Increased bone density in the distal femur. In this patient, the anteroposterior radiograph shows the neoplasm more clearly. Figure 58.2. Increased bone density in the distal femur.[5minuteconsult.com]

Treatment

  • Your treatment team will do everything they can to reduce or prevent side effects of treatment. Does treatment cause infertility? You and your child should talk to your doctor about the reproductive risks associated with cancer treatment.[uchicagomedicine.org]
  • Treatment is usually chemotherapy and surgery. Surgery may be limb-sparing or amputation. Ongoing follow-up care during and after treatment is needed.[urmc.rochester.edu]
  • Conclusions: CIRT was safe and efficacious in the treatment of inoperable pediatric osteosarcoma with improved local control and overall survival compared to conventional treatments.[oncotarget.com]
  • Our program offers comprehensive treatment under one roof, something unique in the Twin Cities. We can provide your child with a customized treatment plan that addresses his or her specific needs.[mhealth.org]
  • Chemotherapy is the main treatment, along with surgery to remove the primary tumor. Most children and teens can fully recover from osteosarcoma.[spectrumhealth.org]

Prognosis

  • A delay in the diagnosis has a deleterious effect on the prognosis of osteosarcoma.[ojionline.org]
  • Our study revealed the dismal prognosis of patients with synchronous multifocal osteosarcoma; there were no survivors among the three patients with multifocal disease.[ascopubs.org]
  • One recurrently amplified gene, KDR, was highly expressed in advanced cases and associated with poor prognosis. 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.[onlinelibrary.wiley.com]
  • […] osteosarcoma. ( 26116768 ) Zhuo B...Wang R 2015 35 Bone mineral density change during adjuvant chemotherapy in pediatric osteosarcoma. ( 26512351 ) Ahn JH...Lim JS 2015 36 Upregulated expression of microRNA-214 is linked to tumor progression and adverse prognosis[malacards.org]
  • Maintenance of angiogenin-IgM may also be an important aspect of osteosarcoma tumorigenesis and could be linked to prognosis.[clinicalsarcomaresearch.biomedcentral.com]

Etiology

  • Etiology The etiology of most cases is unknown.[unboundmedicine.com]
  • Several lines of evidence point to the importance of the role of two recessive oncogenes, the retinoblastoma susceptibility gene (RB1) and the p53 gene in the etiology of osteosarcomas.[grantome.com]
  • Etiology and etiopathogenesis Etiology and pathogenesis is usually unknown, most of the osteosarcomas are sporadic.[telemedicina.med.muni.cz]
  • Trauma has not been found to cause osteosarcoma. 1 Describe the Etiology and Pathogenesis of Osteosarcoma Although osteosarcoma is not characterized by a specific gene translocation and has a highly variable genetic profile, several mutations have been[journals.sagepub.com]
  • Etiology/Causes [1] • The pathogenesis and etiology of osteosarcoma remains obscure • Chemical agents such as beryllium • Viruses such as FBJ (which contain the src-oncogene) • Radiation • Paget’s disease • Electrical burn and trauma • Genetic predisposition[physio-pedia.com]

Epidemiology

  • Epidemiology Osteosarcoma is the most common pediatric primary bone cancer and is the 8th most common malignancy of childhood.[unboundmedicine.com]
  • Race The incidence is slightly higher in African Americans than in Caucasians (data from the National Cancer Institute [NCI] Surveillance, Epidemiology, and End Results [SEER] Study Pediatric Monograph, 1975-1995). [1] In African Americans, the annual[emedicine.medscape.com]
  • Epidemiology Annual incidence of osteosarcoma is 3.5–5 : 1 million for persons less than 20 years of the age Osteosarcoma is more common in males than in females, M : F 1.6 - 2 : 1 It is the 6th most common cancer in children 15 let and accounts for 5%[telemedicina.med.muni.cz]
  • Osteosarcoma incidence and survival rates from 1973 to 2004: Data from the surveillance, epidemiology, and end results program. Cancer 2009;115:1531-43. 2. Pattnaik K, Pradhan P, Kar A, Burma S, Panda S.[ojionline.org]
  • Epidemiology of childhood cancer in India. Indian J Cancer. 2009; 46 :264–73. [ PubMed ] [ Google Scholar ] 6. Mohseny AB, Szuhai K, Romeo S, Buddingh EP, Briaire-de Bruijn I, de Jong D, et al.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • […] and increased risk of a range of sarcomas, among other malignancies Rothmund-Thomson syndrome Bloom syndrome Enchondromatosis Hereditary multiple exostoses Fibrous dysplasia Paget disease of the bone, although less relevant to pediatric populations Pathophysiology[unboundmedicine.com]
  • Pathophysiology Osteosarcoma is a bone tumor that can occur in any bone. It most commonly occurs in the long bones of the extremities near metaphyseal growth plates.[emedicine.medscape.com]

Prevention

  • “Knowing the initial results from blocking Notch in mice, we are encouraged to keep investigating the entire metastasis process, so we can find additional therapies and targets to prevent cancer from spreading and growing,” Hughes said in a press release[healio.com]
  • It is given before surgery in order to shrink the tumor, and in an attempt to prevent or control the spread of the tumor. Chemotherapy after surgery targets potential tumor sites not removed completely by surgery.[uchicagomedicine.org]
  • Therefore, surgical therapy is often supplemented with adjuvant treatment to prevent recurrence.[clinicsinsurgery.com]
  • Based on chemosensitivity of osteosarcoma and in order to prevent amputation the standard treatment is recommended as follows: neoadjuvant (preoperative) chemotherapy – surgery –adjuvant chemotherapy Surgery The mail goal for the surgery is to safely[telemedicina.med.muni.cz]
  • Understanding these side effects can help you, your child, and your care team prepare for, and, in some cases, prevent these symptoms from occurring.[danafarberbostonchildrens.org]

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