Osteosarcoma

Introduction to osteosarcoma Osteosarcoma refers to a malignant connective tissue tumor in which tumor cells can directly produce tumor bone and bone-like tissue, and its incidence ranks first in primary malignant tumors. The degree of malignancy is very high, and the post-mortem is extremely poor. Pulmonary metastasis can occur within a few months. The survival rate is only 5-20% after 3 to 5 years after amputation. It occurs in the lower end of the femur and at the upper end of the tibia. It accounts for about three-quarters of all osteosarcoma. Others such as the humerus, the upper end of the femur, the tibia, the spine, and the tibia can also occur. Most of them are osteolytic, and a few are osteogenic. The age of onset can occur at any age, but most of them are between 10 and 25 years old, and there are more men. The tumor is mostly at the end of the bone, and occasionally occurs in the backbone or epiphysis. basic knowledge The proportion of illness: 0.0005% Susceptible people: men who are born in 10 to 25 years old Mode of infection: non-infectious Complications: heart disease, fracture, diabetes

Osteosarcoma etiology

Osteosarcoma is the same as other human tumors, the cause is unclear, the mechanism is unknown, and its pathogenesis is very complicated. The internal factors include quality theory, genetic theory, endocrinology, etc.; external factors include chemical substances and internal and external irradiation, chronic inflammation stimulation theory, viral infection theory, etc. . Other benign bone tumors such as Paget's disease, giant cell tumor of bone and poor structure of bone fibrous tissue may be secondary to osteosarcoma, which is more common in patients after middle age.

Osteosarcoma prevention

The focus of prevention is the spread of cancer-related medical knowledge, which has led to increased awareness and understanding of osteosarcoma and increased vigilance. Health conditions and improved quality of health care are the guarantees of early detection. Pain in the proximal joints with no history of trauma, especially in adolescents, should be treated as soon as possible to exclude osteosarcoma. The disease may be related to some external stimuli, such as X-rays, etc., should avoid contact and attention to protection. Some benign lesions can also be converted into osteosarcoma, such as osteochondroma, giant cell tumor, bone fiber dysplasia, etc., patients with these diseases should be reviewed regularly according to the doctor's advice.

Osteosarcoma complications Complications, heart disease, diabetes

Due to the doubling of osteosarcoma, patients can generally live for 15 months to 5 years. Possible complications include heart disease, lung disease and diabetes. 60%-70% of patients with osteosarcoma can continue to survive. Potential complications include Surgery causes cancer cells to spread to the lungs.

Can be complicated by pathological fractures, osteosarcoma occurring in the long bones of the bone can be complicated by osteosclerotic lesions and thickening of the periosteum, the tumor near the joint often with dysfunction, lung metastasis often occurs in the late stage.

Osteosarcoma Symptoms Common symptoms Severe pain Pulmonary metastasis Knee joint pain Dyspnea Children Repeated fractures Periosteal reaction Facial deformity Bone cysts Hemoptysis

Pain is an early symptom that can occur before the onset of the tumor, initially as intermittent pain, and gradually becomes persistent severe pain, especially at night. Malignant tumor pain occurs earlier and more intensely, often with a history of local trauma. The tumor at the proximal end of the bone is large, the hardness is different, there is tenderness, the local temperature is high, the vein is dilated, and sometimes the pulsation can be felt. There may be a pathological fracture, and the whole body health gradually declines to failure. Most patients have lung metastasis within one year.

Clinically, it occurs in adolescents. The mandible is less common in the maxilla and has a history of injury. The early symptoms are intermittent numbness and pain in the affected area, which translates into persistent severe pain with reflex pain. The tumor grows rapidly and destroys the teeth. Slots and jaws, tooth loosening, displacement, facial deformity, pathological fractures, irregular lesions on X-ray films, osteolytic expansion from the inside to the outside; osteocortical destruction, substituting hyperplasia The bone mass is osteogenesis in the arrangement of solar radiation. Clinically, there is also a mixed type with the above two types of expression. In the advanced stage, serum calcium and alkaline phosphatase can be elevated, and the tumor is easily transferred to the lung along the blood channel.

The length of the patient's course varies from a few symptoms to a few days, from several years to an average of 3 to 4 months. The predilection is around the knee joint. The earliest clinical symptoms are pain, mostly pain, and persistence. After the activity, the pain is aggravated, the nighttime pain is more obvious, and the affected part has a mass. The growth rate of the mass is often measured in months. When the mass is significantly increased, the reactive effusion of the adjacent joint may occur, the joint activity is limited, and the early pain is often Suddenly after minor injury, the swelling began to be slight, and gradually increased afterwards. It was eccentric fusiform swelling, and the hardness of the mass was different. The tumor texture was different. The osteolytic lesions were softer than the osteogenic bones, and the affected skin was bright. The surface veins dilate and the skin temperature rises. If the tumor is large and close to the joint, it can affect the joint function. Some patients have other parts of the site at the time of treatment.

The size of the tumor volume may vary depending on the depth of the tumor site and the size of the tumor invading the soft tissue. The mass of the tumor is accompanied by tenderness. The hardness varies depending on the amount of bone tissue contained in the tumor tissue. When the tumor is large, it may appear. Vascular engorgement on the surface of the skin.

The most common site of the disease is the tubular bones of the extremities (80%), especially the femur (40%), the tibia (16%) and the tibia (15%), the distal femur, the proximal humerus and the proximal humerus are the most common. The site, 50% to 75% of osteosarcoma occurs near the knee joint, osteosarcoma in the humerus, hip, mandible, maxilla and spine bones is relatively rare, skull, ribs, scapula, clavicle, sternum, ulna, humerus Small bone osteosarcoma of the hands and feet is rare. In the long tubular bone, osteosarcoma mainly occurs in the dry area, and osteosarcoma occurs in the backbone of about 2% to 11%. Osteosarcoma can spread to the sacral end, especially when the tarsal plate After closure, osteosarcoma, which occurs at the end of the bone, is very rare. Epiphyseal osteosarcoma is mainly found in the femoral condyle.

The patient's time from the onset of symptoms to the hospital visit is more than 2 to 4 months. If the osteosarcoma cells are better differentiated, the time for visiting the hospital is later, and the symptoms may be about half a year. The patient's general condition is good at the time of the treatment, and the disease can develop to the later stage. There is fever, weight loss, anemia and other poisoning phenomena. Patients with lung metastases can be asymptomatic in the initial lungs, hemoptysis, convulsions and difficulty breathing in the late stage.

Subtype of osteosarcoma:

1. Capillary vasodilating osteosarcoma: less, only 5%, is a higher malignant osteosarcoma, a short history, rapid tumor growth, X-ray film is osteolytic destruction, the tumor of the general specimen is fusiform swelling , cortical thinning, reddish brown blood sinus, tumor tissue in the sinus wall, microscopically: malignant tumor cells and tumorous bone-like tissue in the blood-filled cavity, X-ray film and low magnification observation similar to aneurysm A bone cyst.

2. Small round cell osteosarcoma is rare, with high malignancy and poor prognosis. X-ray films are osteolytic destruction. The gray-white fish is seen by the naked eye. The microscope consists of a large number of dense small round cells. The cells are round and oval. Shape, short fusiform, unclear envelope, small cell mass, nuclear size, nucleoli are unclear, connective tissue is separated between cells, and tumorous bone-like tissue can be seen between cells.

3. Fibrous tissue cell type osteosarcoma: The age of onset is usually after the third age group. X-ray films are osteolytic lesions involving the long bone ends, sometimes with cotton-like or cloud-like shadows, and few typical periosteum. Reaction, microscopic view of characteristic pleomorphic spindle cells and multinucleated giant cells, many multinucleated giant cells have strange nucleus, sometimes with inflammatory background, characteristic car-like or spiral arrangement, sometimes cells can have a few Protuberances, like all osteosarcoma, are diffusely arranged, and typical tumor-like bone and bone-like tissue formation can be seen under the microscope.

4. Intramedullary well-differentiated osteosarcoma: rare, is a low-grade osteosarcoma, with a relatively high age of onset, mild symptoms, X-ray similar fibrous heteroplasia, but the boundary is unclear, invading or penetrating the cortex, gross specimen It is an off-white rubber sample. Under the microscope, there are a large number of proliferating fibroblasts. These nuclei are deeply stained and have different shapes, and there are a number of tumor-like bone-like tissues and bones between cells.

5. Multi-center osteosarcoma: Modern scholars believe that osteosarcoma is a systemic disease, most of which are single-shot lesions and small lesions that cannot be detected by modern detection methods. Many hair styles are rare, and multiple tumor lesions appear at the same time. The patient was first with a single lesion, and then gradually developed multiple times, all of which occurred in long bones. The X-ray showed osteogenesis, AKP was high, the prognosis was poor, and there was no visceral metastasis.

6. Cortical osteosarcoma is rare, lesions often occur in the cortical bone of the humeral shaft, X-ray has a light-transmitting area in the cortex, surrounded by sclerosis, similar to osteoid osteoma, mirrored with common osteosarcoma , can relapse and metastasize.

7. Osteosarcoma of the bone is common, which occurs in the posterior side of the femur in patients aged 30 to 40 years. The typical X-ray shows a fairly dense shadow. It is located on the surface of the normal cortical bone and invades the surrounding soft tissue. X-ray or CT can be seen. There is a radio-transparent gap between the tumor and the cortex. The surface of the tumor is completely lobulated, with irregular edges. The tumor is a highly hardened mass. Under the microscope: the tumor is a large number of proliferating spindle cells with mild heteromorphism. Nuclear fission is rare. Among them, medium-sized collagen fibers can be seen. Tumorous bone and bone-like tissue can be seen between these fusiform cells. There are fashionable and well-differentiated intraosseous lesions with good prognosis.

8. Dedifferentiation of osteosarcoma of the bone: rare, can be developed from low-grade malignant para-osseous osteosarcoma or from a previously resected low-grade malignant para-osseous osteosarcoma to a highly malignant tumor, X-ray similar to the traditional type Osteosarcoma, microscopically differentiated spindle-shaped cell components, parallel and irregular trabecular bone arrangement, high-grade interstitial sarcoma components can be seen in adjacent parts and visible tumor bone and bone-like tissue formation, the prognosis is similar to the traditional Osteosarcoma.

9. Periosteal osteosarcoma is rare, occurs on the surface of young people's long bones, grows outward to form a translucent soft tissue mass, the edge is unclear, the radial bone needle is perpendicular to the long bone in the middle, and the macroscopic tumor is lobulated. There are obvious cartilage, including calcification and ossification. Microscopically, the lamellar malignant cartilage tissue can be seen to produce fine lace-like bone-like tissue. The late stage of the lesion can invade the medullary cavity, and the prognosis is good.

10. Highly malignant surface osteosarcoma: less common, often occurs on the surface of the femoral shaft, the surface of the cortical bone is not connected to the medullary cavity, X-ray is like periosteal osteosarcoma, the tumor is large in size, common hemorrhagic necrosis, under the microscope For highly variable tumors, the cells form neoplastic bone and bone-like tissue with the same prognosis as traditional osteosarcoma.

Osteosarcoma examination

(1) Radioisotope bone scan imaging: Whole body radionuclide bone scan can identify the primary site of osteosarcoma and the site of bone and bone metastasis. The method is simple, the location is clear, and more applications are used in clinical diagnosis.

(2) Angiography: It can provide the boundary of osteosarcoma and the pressure of blood vessels around the osteosarcoma and the blood supply of tumor tissue. Provide a basis for preoperative interventional vascular embolization.

(3) CT examination: Through three-dimensional reconstruction of images, the extent of intramedullary and soft tissue invasion of osteosarcoma can be determined. CT also helps to clarify the diagnosis of "jumping metastasis" of osteosarcoma. Good quality CT images help doctors design treatments before surgery, especially in the design of limb salvage programs.

(4) Nuclear magnetic resonance (MRI): Complementing the CT examination, the image of the scope of invasion of osteosarcoma in the intramedullary and surrounding soft tissues is clearer.

(5) Pathological examination: It is of great significance for the classification and clinical diagnosis of osteosarcoma.

Gross examination: Osteosarcoma is hard and has a grainy texture. The cut flour is red and grayish white is "bad fish". Osteogenic osteosarcoma showed yellow-white, hard; cartilage-forming type showed gray-blue, shiny, hard and tough; fiber-forming type dark red or gray-yellow, soft. Osteosarcoma tissue hemorrhage is more purple-red; the middle of the necrotic area is cystic.

Microscopy: Histology is characterized by the direct osteogenesis of tumor cells and the production of bone matrix. Microscopically, it contains polymorphic matrix, irregular or fusiform tumor cells, large nuclei, deep staining, and abnormal nuclear mitotic figures. If the tissue specimen contains a large number of sarcomatoid stroma, the tumor bone and bone-like tissue are not difficult to distinguish, but some tissue sections do not see the tumor bone-like tissue; only collagen surrounds the tumor cells; only the cells with inactive tumor growth are visible. Interstitial; some are mainly neonatal cartilage and atypical prismatic cells.

Pathological findings combined with clinical and imaging examinations are the main methods for the diagnosis of osteosarcoma.

Increased serum alkaline phosphatase is the only important laboratory test for osteosarcoma.

X-ray examination is of great value in the diagnosis of osteosarcoma. It is common to have tumorous bone formation, which is characterized by cloud-like or plaque-like density. These cases are called sclerosing osteosarcoma. A small number of cases are osteolytic, and the pathologically mainly chondrocyte type and fibroblast type are mainly bone destruction, X-ray is worm-like or large-scale bone destruction, and the boundary is blurred. In addition, X-ray findings such as Codman triangle or solar radiation, is very helpful for the diagnosis of osteosarcoma.

Microscopic examination: For differentiated tumor cells, neoplastic osteogenesis is more obvious. In the fibrous skeletal plexus, the fibrous tissue is more proliferative, and the dysplasia is not obvious. A small number of poorly differentiated paracortical osteosarcoma, with less bone formation, are similar to common osteosarcoma.

Diagnosis and diagnosis of osteosarcoma

Gross examination: Osteosarcoma is hard and has a grainy texture. The cut flour is red and grayish white is "bad fish". Osteogenic osteosarcoma showed yellow-white, hard; cartilage-forming type showed gray-blue, shiny, hard and tough; fiber-forming type dark red or gray-yellow, soft. Osteosarcoma tissue hemorrhage is more purple-red; the middle of the necrotic area is cystic.

Microscopy: Histology is characterized by the direct osteogenesis of tumor cells and the production of bone matrix. Microscopically, it contains polymorphic matrix, irregular or fusiform tumor cells, large nuclei, deep staining, and abnormal nuclear mitotic figures. If the tissue specimen contains a large number of sarcomatoid stroma, the tumor bone and bone-like tissue are not difficult to distinguish, but some tissue sections do not see the tumor bone-like tissue; only collagen surrounds the tumor cells; only the cells with inactive tumor growth are visible. Interstitial; some are mainly neonatal cartilage and atypical prismatic cells.

Pathological findings combined with clinical and imaging examinations are the main methods for the diagnosis of osteosarcoma.

Increased serum alkaline phosphatase is the only important laboratory test for osteosarcoma.

X-ray examination is of great value in the diagnosis of osteosarcoma. It is common to have tumorous bone formation, which is characterized by cloud-like or plaque-like density. These cases are called sclerosing osteosarcoma. A small number of cases are osteolytic, and the pathologically mainly chondrocyte type and fibroblast type are mainly bone destruction, X-ray is worm-like or large-scale bone destruction, and the boundary is blurred. In addition, X-ray findings such as Codman triangle or solar radiation, is very helpful for the diagnosis of osteosarcoma.

Microscopic examination: For differentiated tumor cells, neoplastic osteogenesis is more obvious. In the fibrous skeletal plexus, the fibrous tissue is more proliferative, and the dysplasia is not obvious. A small number of poorly differentiated paracortical osteosarcoma, with less bone formation, are similar to common osteosarcoma.

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