Diagnosis and treatment of low-grade osteosarcoma: experience with nine cases

• Published in: International journal of clinical oncology 2014-08, Vol.19 (4), p.731-738
• Main Authors: Hayashi, Katsuhiro, Tsuchiya, Hiroyuki, Yamamoto, Norio, Shirai, Toshiharu, Nishida, Hideji, Takeuchi, Akihiko, Kimura, Hiroaki, Miwa, Shinji, Inatani, Hiroyuki, Okamoto, Hideki, Yamada, Satoshi, Ikeda, Hiroko, Sawada-Kitamura, Seiko, Nojima, Takayuki, Ooi, Akishi, Otsuka, Takanobu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers, Tumor - biosynthesis; Biopsy; Bone cancer; Bone Neoplasms - diagnosis; Bone Neoplasms - pathology; Cancer Research; Cancer surgery; Cyclin-Dependent Kinase 4 - biosynthesis; Female; Gene Expression Regulation, Neoplastic; Humans; Male; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Oncology; Original Article; Osteosarcoma - diagnosis; Osteosarcoma - pathology; Proto-Oncogene Proteins c-mdm2 - biosynthesis; Surgical Oncology; Surgical outcomes
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-013-0592-z

Background Low-grade osteosarcoma, including low-grade central osteosarcoma and parosteal osteosarcoma, is an extremely rare variant, and the diagnosis is occasionally difficult. In this article we present cases of low-grade osteosarcomas that should be reviewed by a clinical oncologist. Patients and methods Nine cases of histologically diagnosed Broder grade 1 osteosarcoma were retrospectively reviewed. The pathological diagnoses included parosteal osteosarcoma, low-grade central osteosarcoma, and low-grade chondroblastic osteosarcoma in four, four, and one cases, respectively. Results Duration from initial surgical intervention including biopsy to final diagnosis as low-grade osteosarcoma was a mean of 9.4 months. The initial benign diagnoses on biopsy specimens included fibrous dysplasia in three cases, chondroblastoma in one case, and a giant cell tumor in one case. The average number of histological examinations was 1.8. Low-grade osteosarcomas are well suited for biological reconstruction: seven cases were reconstructed by frozen autografts, distraction osteogenesis, or vascularized bone grafts. Conclusion Low-grade osteosarcomas can be misdiagnosed as benign lesions, especially fibrous dysplasia. If the diagnosis of a low-grade osteosarcoma is not established on the basis of radiologic findings, care should be exercised, even when a biopsy suggests a benign lesion. Low-grade osteosarcomas should be treated with wide excision, even after an intralesional excision. Biological reconstruction might be a better option for low-grade osteosarcomas.