Telangiectatic Osteosarcoma in a Young Child – A Case Report and Review of the Literature

Introduction: Osteosarcoma (OS) is one of the most common primary malignant bone tumors in children and adolescents. OS incidence varies significantly with age and peak incidence is in adolescent age group. Telangiectatic osteosarcoma (TOS) is an unusual variant of OS, forming 3–10% of all OSs. Only few case reports of this rare variant of OS are described in the literature. Case Report: We report a 6-year-girl who presented with fracture of the left proximal humerus after a trivial trauma. X-ray left shoulder showed osteolytic lesions in the left proximal humerus with fracture of proximal humerus. Open biopsy from the left proximal humerus osteolytic lesion suggested clusters of highly atypical cells like osteoid material and focal areas of hemorrhage and necrosis suggestive of TOS. The child was started on chemotherapy followed by limb-salvage surgery with wide resection of the tumor in the left proximal humerus. She completed her adjuvant chemotherapy and is currently doing well for the past 4 years. Conclusion: OS occurs more frequently in adolescents around the knee in the metaphyses. The most common histologic type is osteoblastic/fibroblastic or chondroblastic type. Very few cases have been reported in <5 years age group and it’s relatively rare in 5–10-year-old children. Rare histologic variants, especially telangiectatic variant, are more common in younger children and occur more in upper limbs. Imaging reveals mainly osteolytic lesions, unlike in conventional OS. This case highlights the utmost role of histopathology in the diagnosis of the bone tumors which would guide the management appropriately. Keywords: Osteosarcoma, pathological fracture, expansile lytic lesion, telangiectatic osteosarcoma.

Osteosarcoma of III metacarpal bone in a 13-year-old girl (case report)

Osteosarcoma is the most common primary malignant neoplasm of bones in children; this tumor accounts for 50 to 80% of all skeletal sarcomas. Less often, osteosarcoma affects flat bones (scapula, ribs, bones of the skull and pelvis), bones of the foot, hand and spine. Description of the observation. A 13-year-old girl, 8 months before admission to the clinic, began to complain of pain in her right hand, six months later, a swelling appeared in this area. After radiography, which revealed a bone tumor of the III metacarpal bone, a trepanobiopsy with histological examination was performed. Conclusion: subperiosteal telangiectatic osteosarcoma G II. The child was admitted to the oncology department in November 2018. Before the operation, the girl underwent 4 courses of chemotherapy, as a result of which the tumor reduced in size, which made it possible to perform organ-preserving surgical treatment extirpation of the third metacarpal bone affected by the tumor, followed by autoplasty from the wing of the right iliac bone with fixation of the graft Kirschner needles. The postoperative period passed without complications. As a result of the operation, it was not only possible to radically remove the tumor, but also to preserve 3 fingers of the right (working) hand with good functionality. After surgery, the child received 5 courses of polychemotherapy and is currently in remission. Conclusion. The above observation demonstrates the possibility of performing organ-preserving surgeries using bone autoplasty for rare tumor lesions of the metacarpal bones. This method is more physiological in comparison with the use of allo- or artificial grafts.

The transformation of aneurysmal bone cyst into telangiectatic osteosarcoma: the development of a second tumour or a wrong initial diagnosis?

Aneurysmal bone cyst (ABC) and telangiectatic osteosarcoma (TOS) share a lot of similarities in terms of the initial clinical presentation, the radiological semiotics and even the morphological pattern, however, they are completely different nosological entities requiring absolutely different treatment approaches. This article reports a clinical case of TOS of the femur which developed 1.5 years after the treatment of ABC of the same location and presents an analysis of literature on the differential diagnosis of these diseases, the modern concept of the pathogenesis of ABC and the possibility of the transformation of ABC into TOS. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications.