Low-grade central osteosarcoma in proximal humerus: a rare entity

Abstract

Low-grade central osteosarcoma is a rare subtype of tumor with low-grade malignancy. Currently, wide resection with negative resection margin is the standard treatment for this disease. The role of neoadjuvant chemotherapy in low-grade central osteosarcoma was controversial and was mostly considered for tumors containing high-grade focal areas. Local tumor recurrences often exhibited a tumor with higher histologic grade or differentiation with the potential for metastases. In low-grade central osteosarcoma, timely wide resection after definite diagnosis can result in 5-year survival for almost 90%. However, the relatively nonspecific radiological and pathological findings make diagnosis very difficult. MDM2 and CDK4 are specific and provide sensitive markers for the diagnosis of low-grade central osteosarcoma, helping to differentiate low-grade central osteosarcoma from some benign lesions, including fibrous dysplasia, bone giant cell tumor, and chondrosarcoma. Here, we report the case of a 19-year-old woman with low-grade central osteosarcoma located at the proximal humerus. The affected site was rare, but the sensitive biomarkers CDK4 and MDM2 were positive. The patient recovered well after wide tumor resection following a proximal humerus endoprosthesis replacement. Our case highlighted the management strategies in low-grade central osteosarcoma. Being familiar with radiographic features, understanding the biological characteristics, and mastering diagnostic biomarkers can help oncologists avoid embarrassing situations in treatment when this rare tumor is highly suspected, even when located at an uncommon site. The discussion in this report focuses on radiographic and pathological features, advances of biomarkers that help in differential diagnosis, and current treatment options in low-grade central osteosarcoma.

Intramedullary Well-Differentiated Osteosarcoma: Imaging and Pathologic Findings in a Group of 17 Patients

“…This type of bone osteosarcoma was rst described by Unni et al in 1977 3,4 , and later the World Health Organization described it as low-grade central osteosarcoma (LGCOS) 5 . Unlike most osteosarcomas, LGCOS is less aggressive with limited metastatic potential and a good prognosis 4,6 . Nonetheless, the tumor may recur locally to exhibit greater malignancy with an increased potential for metastasis 7,8 , and the current standard treatment modality for LGCOS is wide resection with a negative margin.…”