Bone Tumors Occurring in the Soft Tissues: A Review of the Clinical, Imaging, and Histopathologic Findings

Veselis, Clinton A.; Awan, Omer A.; Thomas, Ashanth; Ling, Stephen; Jonnalagadda, Padmaja; Aneja, Amandeep; Ali, Sayed

doi:10.1067/j.cpradiol.2020.06.004

Cited by 9 publications

(6 citation statements)

References 44 publications

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“…The most common and important signs in radiography are the periosteal reaction and a Codman triangle ( 10 ). OS of bone attains a peak in children and early adolescents, with a second peak in adults >65 years of age ( 8 ). However, ESOS mainly occurs in middle-aged and elderly individuals ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…According to the degree of hemorrhage and necrosis, both CT and MR images have varying degrees of uneven enhancement. Owing to their complex composition, the methods of enhancement also vary ( 8 ). The intratumoral calcification in this patient with ESOS was a characteristic sign, and calcification could be detected sensitively using CT images.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical features lack specificity, while some patients may be asymptomatic ( 2 , 7 ). While any type of primary bone tumor can potentially originate in the soft tissues, the vast majority of these extraskeletal lesions constitute osteosarcomas, chondrosarcomas, or Ewing’s sarcoma ( 8 ). ESOS originates from mesenchymal stem cells (MSCs) and can produce osteoids ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

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A Primary Extraskeletal Osteosarcoma of the Spleen: Rare Case Report

Pan

Wang

Lin³

et al. 2022

Front. Oncol.

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Extraskeletal osteosarcoma is a rare malignant soft-tissue sarcoma that is difficult to diagnose. Surgery is a common treatment, although chemotherapy and radiotherapy are also used. Patients at risk of bleeding can undergo embolization combined with resection. The occurrence of primary splenic extraskeletal osteosarcoma in humans does not seem to have been reported in the literature. A 50-year-old woman who complained of pain in the left upper abdomen for 1 day was initially diagnosed with “splenic hemangioma with a high possibility of rupture and bleeding” and urgently underwent digital subtraction angiography, combined with splenic arteriography and embolization. Abdominal pain worsened 2 days postoperatively, with a hemoglobin level of 106.0 g/L. Consequently, emergency laparotomy combined with splenectomy was performed. The clinical and imaging features, pathological diagnosis, and embolization treatment of this case were analyzed retrospectively. CT of the upper abdomen revealed splenomegaly, an irregular low-density shadow in the spleen, and a flake-like calcification in the lateral margin of the left kidney. Nuclear MRI of the upper abdomen showed splenomegaly and a mass (approximately 8.4 cm × 5.7 cm × 6.3 cm) below the spleen with clear boundaries—this exhibited an uneven signal, which was slightly low in T1-weighted imaging (T1WI) and slightly high in T2-weighted imaging (T2WI). Several small cystic lesions or cystic cavities were observed in the mass, which exhibited a longer T2 signal. During the enhanced scan, the signal of the lesion showed progressive enhancement, and the enhancement range increased in the delayed phase scan, as well as a hematoma below the spleen capsule and calcification below the lesion (nodular T1WI/T2WI hypointense, approximately 3.3 cm × 3.6 cm). Postoperative biopsy pathology showed splenic soft tissue tumor: at low magnification, the multinucleated giant cells were scattered; at medium magnification, osteoclast-like multinucleated giant cells were observed; and at high magnification, lace- or grid-like tumor osteogenesis was detected. Immunohistochemistry showed that the expression of CD31, CD34, F8, s-100, desmin, SMA, and CD99 was negative, whereas the expression of β-catenin, BCL-2, SATB-2, and P16 was positive. CD68 and MDM-2 showed low expression, while 50% of the cells were positive for Ki-67 expression. No abnormal concentration of radioactivity was found on the bone scan with 99mTc-MDP after the operation, further ruling out the occurrence of other bone tumors. The patient was diagnosed with primary extraskeletal osteosarcoma. It is necessary for multidisciplinary teams to diagnose malignant extraskeletal osteosarcomas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Primary Extraskeletal Osteosarcoma of the Spleen: Rare Case Report

Pan

Wang

Lin³

et al. 2022

Front. Oncol.

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“…There are few studies on the imaging manifestations of EOS, and most are case reports. The imaging features of the disease are poorly understood by radiologists and clinicians, and the accuracy of preoperative imaging diagnosis is not high [ 5 – 7 ]. Diagnosis is usually made by needle biopsy or open biopsy.…”

Section: Introductionmentioning

confidence: 99%

Imaging diagnosis and differential diagnosis of extraskeletal osteosarcoma

Wang,

Zhang,

Lin

et al. 2024

BMC Cancer

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Objective The aim of this study was to investigate the clinical, imaging and pathological features of extraskeletal osteosarcoma (EOS) and to improve the understanding of this disease and other similar lesions. Methods The data for 11 patients with pathologically confirmed extraosseous osteosarcoma, including tumour site and size and imaging and clinical manifestations, were analysed retrospectively. Results Six patients were male (60%), and 5 were female (40%); patient age ranged from 23 to 76 years (average age 47.1 years). Among the 11 patients, 7 had clear calcifications or ossification with different morphologies, and 2 patients showed a massive mature bone tumour. MRI showed a mixed-signal mass with slightly longer T1 and T2 signals in the tumour parenchyma. Enhanced CT and MRI scans showed enhancement in the parenchyma. Ten patients had different degrees of necrosis and cystic degeneration in the mass, 2 of whom were complicated with haemorrhage, and MRI showed “fluid‒fluid level” signs. Of the 11 patients, five patients survived after surgery, and no obvious recurrence or metastasis was found on imaging examination. One patient died of lung metastasis after surgery, and 2 patients with open biopsy died of disease progression. One patient died of respiratory failure 2 months after operation. 2 patients had positive surgical margins, and 1 had lung metastasis 6 months after operation and died 19 months after operation. Another patient had recurrence 2 months after surgery. Conclusion The diagnosis of EOS requires a combination of clinical, imaging and histological examinations. Cystic degeneration and necrosis; mineralization is common, especially thick and lumpy mineralization. Extended resection is still the first choice for localized lesions. For patients with positive surgical margins or metastases, adjuvant chemoradiotherapy is needed.

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“…Ewing’s sarcoma (ES) is a malignancy that arises from bones or soft tissue, characterized by primitive small and round blue cells. [ 9 ] ES is relatively uncommon, accounting for 6%–8% of primary bone tumors, however, is the second most commonly encountered primary bone and soft-tissue cancer in children and adolescents. [ 4 ] This tumor is of neuroectodermal origin, arising from primitive neural crest cells.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of primary Ewing’s sarcoma of the petroclival bone extend into the sphenoid sinus: A case report and review of literatures

Shimabukuro¹,

Suzuki²,

Nakano³

et al. 2021

Surgical Neurology International

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Background: Ewing’s sarcoma (ES) is a malignancy that arises from bones or soft tissue, characterized by primitive small and round blue cells. Primary ES typically occurs in the long bones, vertebrae, or pelvis, and is extremely rare in the skull base. Case Description: A 14-year-old girl presented with posterior cervical pain and dysfunction of multiple cranial nerves (CNs). Radiological investigation revealed a solid mass of the petroclival bone extending into the sphenoid sinus. The patient underwent endoscopic transsphenoidal surgery for diagnosis of the pathology, and partial resection was safely achieved. Histopathological, genetic, and radiological examinations confirmed the diagnosis of primary ES. Subsequently, the patient underwent adjuvant chemotherapy and radiotherapy following which the clinical symptoms resolved. Complete response was achieved after multimodal treatment. Twenty months after treatment, the patient remains in remission without recurrence or metastatic disease. Primary ES of the petroclival bone has been reported in only three cases in the literature. As seen in the present case, dysfunction of multiple CNs is the most common manifestation of petroclival ES. Diagnosis should be confirmed by histopathological and genetic examinations considering the nonspecific clinical symptoms and radiological features. Conclusion: Multimodal treatment, including surgery, chemotherapy, and radiotherapy, can result in favorable outcomes. Clinicians should consider safe resection during surgical management to prevent complications that can delay postoperative multimodal treatment.

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Bone Tumors Occurring in the Soft Tissues: A Review of the Clinical, Imaging, and Histopathologic Findings

Cited by 9 publications

References 44 publications

A Primary Extraskeletal Osteosarcoma of the Spleen: Rare Case Report

A Primary Extraskeletal Osteosarcoma of the Spleen: Rare Case Report

Imaging diagnosis and differential diagnosis of extraskeletal osteosarcoma

Surgical management of primary Ewing’s sarcoma of the petroclival bone extend into the sphenoid sinus: A case report and review of literatures

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