Acute respiratory failure as initial manifestation of conventional osteosarcoma rich in giant cells: a case report

Abstract

Background Osteosarcoma is a malignant tumor of the bone. The giant cell-rich osteosarcoma (GCRO) is a rare histological variant of the conventional osteosarcoma, accounting for 3% of all osteosarcomas. It has a variable clinical presentation, ranging from asymptomatic to multiple pathological fractures, mainly involving long bones, and less frequently the axial skeleton and soft tissues. Case presentation We present the case of a 25-year-old Hispanic woman, previously healthy, with a 1-month history of dyspnea on exertion, intermittent dry cough, hyporexia, and intermittent unquantified fever. She presented to the emergency department with a sudden increase in dyspnea during which she quickly entered ventilatory failure and cardiorespiratory arrest with pulseless electrical activity. Resuscitation maneuvers and orotracheal intubation were initiated, but effective ventilation was not achieved despite intubation and she was transferred to the intensive care unit of our institution. The chest radiograph showed a mediastinal mass that occluded and displaced the airway. The chest tomography showed a large mediastinal mass that involved the pleura and vertebral bodies. A thoracoscopic biopsy was performed that documented a conventional giant cell-rich osteosarcoma. The patient was considered to be inoperable due to the size and extent of the tumor and subsequently died. Conclusions The giant cell-rich osteosarcoma is a very rare histological variant of conventional osteosarcoma. Few cases of this type of osteosarcoma originating from the spine have been reported in the literature, and to our knowledge none of the reported cases included invasion to the chest cavity with airway compression and fatal acute respiratory failure that was present our case. Radiological and histological features of the GCRO must be taken into account to make a prompt diagnosis.

Giant cell‐rich osteosarcoma: A match pair analysis of 11 new cases and literature review of 56 patients

“…Literature search revealed 56 cases of GCRO published between 1986 and 2022 in a total of 34 studies, with 36 cases reported from Asia (64%; Table 3). 10–12,18–50 Mean age was 26 years (range, 5–73 years) and 28 were males (50%). Localizations were reported as follows: Femur (38%; n = 21; 10 times distal, 8 times diaphyseal, 2 times proximal, 1 time unspecified), tibia (27%; n = 15; 14 times proximal, 1 time diaphyseal), mandible ( n = 5), vertebrae C6 to T6 ( n = 4), maxilla ( n = 2), proximal fibula ( n = 2), proximal ulna ( n = 2), foot ( n = 2; first metatarsal, medial cuneiform), 11th rib ( n = 1), skull base ( n = 1), and distal radius ( n = 1).…”

Spinal giant cell-rich osteosarcoma-diagnostic dilemma and treatment strategy: A case report

“…Therefore, the survival rate of primary osteosarcoma in pediatric spine is 18% at 5 years and 7% with distant metastasis[ 21 ]. However, gross total tumor resection should be attempted since it directly affects the prognosis[ 2 , 7 , 8 ]. A recent meta-analysis study also revealed the beneficial outcome after salvage surgery for residual primary spinal osteosarcoma[ 22 ].…”

“…It accounts for approximately 3% of osteosarcomas and mostly occurs in the long bones[ 5 ]. Spinal GCROs are extremely rare, with challenging diagnosis and management compared with long-bone GCRO[ 7 ].…”

Giant cell-rich osteosarcoma of the lumbar spine – A rare entity

“… 7 In contrast to long-bone GCRO, spinal GCRO is incredibly rare and poses unique challenges for its diagnosis and management. 8 Because of the difficulty in differentiating between its clinical, radiological and histopathological features, osteosarcoma of the spine is frequently initially misinterpreted as an aggressive benign vertebral lesion like osteoblastoma or aneurysmal bone cyst and can sometimes can be mistaken for chondrosarcoma or malignant giant cell tumour (GCT). 1 , 9 A biopsy is therefore usually indicated.…”