Radiology. 2003 Nov;229(2):545-53. Epub 2003 Sep 25.
Telangiectatic osteosarcoma: radiologic-pathologic comparison.
Murphey MD, wan Jaovisidha S, Temple HT, Gannon FH, Jelinek
JS, Malawer MM.
Department of Radiologic Pathology, Armed
Forces Institute of Pathology, 6825
16th Street NW, Bldg 54, Rm M127A, Washington, DC 20306, USA.
murphey@afip.osd.mil
PURPOSE: To describe the imaging characteristics
of a large series of
telangiectatic osteosarcomas with pathologic findings for
comparison. MATERIALS
AND METHODS: The authors retrospectively reviewed 40 pathologically
confirmed
telangiectatic osteosarcomas. Patient demographics and images
from radiography
(n = 36), bone scintigraphy (n = 17), angiography (n = 4),
computed tomography
(CT) (n = 25), and magnetic resonance (MR) imaging (n = 27)
were evaluated by
three authors in consensus for lesion location, size, and
intrinsic
characteristics. There were 27 men (68%) and 13 women (32%)
in the study, with
an age range of 4-83 years (mean age, 24 years). RESULTS:
Lesions frequently
affected the femur, tibia, and humerus. Radiographs showed
geographic bone
lysis, a wide zone of transition, and matrix mineralization.
CT demonstrated low
attenuation, MR demonstrated high signal intensity on T2-weighted
images, and
both demonstrated hemorrhage, which simulated the appearance
of aneurysmal bone
cyst. Viable sarcomatous tissue surrounding hemorrhagic and/or
necrotic regions
was best seen at contrast material-enhanced CT and MR imaging,
with thick
peripheral, septal, and nodular enhancement in all cases.
Subtle matrix
mineralization in this viable tissue was best seen at CT.
An associated
soft-tissue mass was also seen in 19 of 25 cases (76%) at
CT and in 24 of 27
cases (89%) at MR imaging. CONCLUSION: CT and MR imaging findings
of
telangiectatic osteosarcoma often include thick nodular tissue
(and matrix
mineralization at CT) in a largely hemorrhagic and/or necrotic
osseous lesion
with an associated soft-tissue mass, which allows distinction
from aneurysmal
bone cyst.
Cancer. 2003 Jun 15;97(12):3068-75.
Neoadjuvant chemotherapy for
high-grade central osteosarcoma of the extremity.
Histologic response to preoperative chemotherapy correlates
with histologic
subtype of the tumor.
Bacci G, Bertoni F, Longhi A, Ferrari
S, Forni C, Biagini R, Bacchini P, Donati
D, Manfrini M, Bernini G, Lari S.
Department of Musculoskeletal Oncology,
Istituto Ortopedico Rizzoli, Bologna,
Italy. gaetano.bacci@ior.it
BACKGROUND: In primary central high-grade
osteosarcoma, a number of distinct
subtypes have been identified, but little is known about the
response to
chemotherapy. METHODS: The authors investigated whether the
subtypes correlated
with histologic response to chemotherapy in 1058 patients
with osteosarcoma of
the extremities who were treated with neoadjuvant chemotherapy
over the last 20
years. The tumors were classified as osteoblastic (70%), chondroblastic
(13%),
fibroblastic (9%), and telangiectatic (6%). At diagnosis,
911 patients had
localized disease and 147 had resectable lung metastases.
RESULTS: The response
to preoperative chemotherapy was good (90% or more tumor necrosis)
in 59% of
patients and poor (< 90% tumor necrosis) in 41% of patients.
The rate of good
responses was significantly higher (P = 0.0001) in the fibroblastic
(83%) and
telangiectatic (80%) tumors and significantly lower in chondroblastic
tumors
(43%). Prognosis was significantly correlated with the histologic
subtypes. The
5-year overall survival rate was significantly higher (P =
0.0001) in
fibroblastic (83%) and telangiectatic (75%) tumors than in
osteoblastic (62%)
and chondroblastic (60%) tumors. In all subtypes, except for
the chondroblastic
subtype, the 5-year overall survival rate was significantly
higher (P = 0.0001)
in good responders P = 0.0001 (68%) than in poor responders
(52%). CONCLUSIONS:
The authors concluded that the histologic subtype of primary
central high-grade
osteosarcoma of the extremity was strictly correlated with
histologic response
to chemotherapy and probably, as a consequence, also with
prognosis. Further
studies are needed to establish whether these results justify
a specific
therapeutic approach based on the histologic subtype of the
tumor. Copyright
2003 American Cancer Society.
Zhonghua Bing Li Xue Za Zhi. 2002 Jun;31(3):213-6.
Telangiectatic osteosarcoma:
a clinicopathologic analysis of 14 cases.
Liu H, Huang X.
Department of Pathology, Beijing Jishuitan
Hospital, Beijing 100035, China.
OBJECTIVE: To investigate the clinicopathologic
characteritics and prognosis of
telangiectatic osteosarcoma. METHODS: The clinical and pathological
data of 14
cases of telangiectatic osteosarcoma were reviewed. RESULTS:
Most of these
patients were male (9/14). The mean age was 23 years. Most
tumors were located
in the lower extremities (10/14). The roentgenograms showed
a large purely
osteolytic lesion. Both medullar and cortical bone were extensively
destroyed.
The gross specimen showed cystic cavities separated by septa,
similar to an
aneurismal bone cyst. Microscopically, the septa contained
anaplastic cells. A
few fine, lace-like osteoid were scattered among these sarcomatous
cells. 12
patients were followed-up from 6 months to 84 months. Of seven
patients who had
developed pulmonary metastasis, six patients died and one
alive with lung
metastasis. The remaining five patients survived after operation.
CONCLUSIONS:
Difficulties in making an early diagnosis and highly malignant
of this disease
might be the important factors that affect the prognosis of
telangiectatic
osteosarcoma.
Mod Pathol. 2001 Dec;14(12):1277-83.
Clinicopathologic analysis of
HER-2/neu immunoexpression among various
histologic subtypes and grades of osteosarcoma.
Kilpatrick SE, Geisinger KR, King TS,
Sciarrotta J, Ward WG, Gold SH, Bos GD.
Department of Pathology, University of
North Carolina, Chapel Hill, North
Carolina 27599-7525, USA. scott.kilpatrick@pathology.unc.edu
Overexpression of the HER-2/neu oncogene
appears to have prognostic significance
in breast cancer. Recently, some have reported a relationship
between increased
immunohistochemical expression in osteosarcoma and poor clinical
outcome.
Despite limited data, a pilot trial of Herceptin, which targets
the oncogene
product, has been initiated for the therapy of some metastatic
osteosarcomas
(CCG-P9852). Archival formalin-fixed, paraffin-embedded tissue
obtained from 41
patients diagnosed with osteosarcoma was examined immunohistochemically
by 2
antibodies against the HER-2/neu oncogene product: CB-11 (monoclonal,
1/100) and
Oncor (polyclonal, 1/200). All but one tumor (case of recurrent
dedifferentiated
parosteal osteosarcoma) represented primary tumor samples;
when applicable, only
prechemotherapy biopsies were analyzed. The study sample included
the full
spectrum of histologic subtypes and grades of osteosarcoma
(25 conventional high
grade; 3 telangiectatic; 1 small cell; 6 parosteal; 1 periosteal;
and 5
low-grade intramedullary). A case of metastatic breast cancer
with known
overexpression of the HER-2/neu oncogene served as the positive
control.
Complete membranous positivity, considered prognostically
significant in breast
cancer, was not seen in any of our osteosarcoma cases. At
least focal
cytoplasmic positivity was documented in 40 (98%) tumors using
the CB11 antibody
and in 34 (83%) using the Oncor antibody. The intensity of
the cytoplasmic
staining (0, 1-3+) did not correlate with histologic subtype/grade,
response to
chemotherapy (<90% versus > or = 90% necrosis), metastasis,
or survival.
Immunohistochemical overexpression of the HER-2/neu oncogene,
defined as
complete membranous positivity, is not present in our series
of osteosarcomas.
Cytoplasmic positivity is observed in most osteosarcomas,
irrespective of
histologic subtype/grade, and is not associated with response
to preoperative
chemotherapy or disease progression.
Pathology. 1999 Nov;31(4):428-30.
Dedifferentiated chondrosarcoma
with features of telangiectatic osteosarcoma.
Radhi JM, Loewy J.
Department of Pathology, College of Medicine,
Royal University Hospital,
University of Saskatchewan, Saskatoon, Canada.
We describe a 44-year-old female with
a known history of a solitary
osteochondroma of the scapula followed on X-ray for five years.
She then
presented with a rapidly growing lump. Imaging studies confirmed
the presence of
an aggressive looking lesion. Excision was performed and pathology
showed a
dedifferentiated chondrosarcoma with features of a telangiectatic
osteosarcoma.
Hum Pathol. 1999 Oct;30(10):1254-9.
Large cell, epithelioid, telangiectatic
osteoblastoma: a unique
pseudosarcomatous variant of osteoblastoma.
Angervall L, Persson S, Stenman G, Kindblom
LG.
Department of Pathology, Sahlgrenska University
Hospital, Goteborg, Sweden.
A previously undescribed large-cell, epithelioid,
and aneurysmal variant of
osteoblastoma with minimal osteoid-production--simulating
telangiectatic
osteosarcoma, epithelioid angiosarcoma, and metastatic carcinoma
is reported.
The tumor occurred in the mandible of a 14-year-old girl.
The light microscopic,
immunohistochemical, ultrastructural, cell proliferation,
and DNA-ploidy
studies, as well as the 7-year disease-free follow-up period
all indicate a
benign osteoblastic tumor. Cytogenetically, the tumor had
a pseudodiploid
karyotype, distinguished by a complex t(1;5;17;22) and a terminal
1q deletion.
Recognition of this unique, pseudomalignant variant of osteoblastoma
is
important to avoid an erroneous diagnosis of malignancy.
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