J Korean Bone Joint Tumor Soc.  2013 Jun;19(1):20-27. 10.5292/jkbjts.2013.19.1.20.

Clinical Outcome of Parosteal Osteosarcoma

• Song WS
• Jeon DG
• Cho WH
• Kong CB
• Cho SH
• Lee KR
• Lee SY

• KMID: 1431656
• DOI: http://doi.org/10.5292/jkbjts.2013.19.1.20

Abstract

PURPOSE
The purpose of this study was to evaluate the oncologic outcomes of parosteal osteosarcoma (POS) and to ascertain the fates of patients after local recurrence (LR).
MATERIALS AND METHODS
The authors retrospectively reviewed 22 POS patients with an average follow-up of 114 months (range: 36-235 months). Seven of the 22 patients were referred after LR. There were 17 Stage IB and 5 Stage IIB (G2, 2; dedifferentiation, 3). Tumors were located in the femur (11) and in other locations (11). Initial surgical margins were wide in 10, marginal in 5, and intralesional in 7. Correlations between clinico-pathologic variables and LR and clinical courses after LR were evaluated.
RESULTS
The 10-year overall survival rate was 85.7%. Three (14%) patients developed distant metastasis and all of them succumbed to the disease. Nine (41%) patients developed LR. Tumor location, resection type, and surgical margin were found to be correlated with LR. At final follow-up, 7 of the 9 patients that experienced local failure achieved no evidence of disease.
CONCLUSION
A substantial risk of misdiagnosis exists, especially for POS in other than a femoral location. Recurrent tumor re-excision is possible in most cases; however, patients with an aggressive recurrence pattern deserve special attention.

Keyword

parosteal osteosarcoma; local recur

MeSH Terms

Diagnostic Errors
Femur
Follow-Up Studies
Humans
Neoplasm Metastasis
Osteosarcoma
Recurrence
Retrospective Studies
Survival Rate

Figure

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  Figure 1. The 10-year overall and event free survival rates were determined using the Kaplan-Meier plot.

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  Figure 2. Patient 21 was a 37-year-old woman who was misdiagnosed as Nora's lesion. (A) Initial anteroposterior radiograph shows an ossified mass on the posterolateral aspect of humerus. (B) This anteroposterior radiograph was taken after 4 episodes of intralesional procedure at referral hospital. Note ill-defined calcified nodules which were located around proximal humerus. (C) The patient underwent segmental excision and reconstruction with recycled autograft. Local recurrence was noted on this anteroposterior radiograph taken after 3 month later. Concomitant metastasis was also identified.

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  Figure 3. A diagram shows the outcome in a meta-analysis of 21 locally recurrent patients. Nearly a half (10/21) of them underwent amputation to manage the local recurrence (LR, local recurrence; NED, no evidence of disease; DOD, dead of disease).

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