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Primary hepatic osteosarcoma.

Nawabi A, Rath S, Nissen N, Forscher C, Colquhoun S, Lee J, Geller S, Wong A, Klein AS - J. Gastrointest. Surg. (2009)

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Cedars-Sinai Medical Center, 8635 W. 3rd Street, 590 West, Los Angeles, CA 90048, USA.

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Extraskeletal osteosarcoma (EOS) is a rare entity... Most human cases have been described in the soft tissues of the limb... Primary hepatic osteosarcoma is extremely uncommon with only seven cases reported in the world’s literature... The lesion extended across the falciform ligament into segment 4 of the liver... It was also adherent to, but did not invade, the stomach... She received a total of four courses of ifosfamide and two courses of cisplatin and doxorubicin with a cumulative dose of doxorubicin of 150 mg/m... The patient has been followed clinically as well as by serial CT imaging of her abdomen, pelvis, and chest... The spindle cells reacted with antibody directed against vimentin and there was no immunostaining for smooth muscle actin (SMA), S-100, desmin, epithelial membrane antigen (EMA), CD 57, or AE1/3... A high mitotic rate with greater than 80% staining for proliferative marker Ki-67 was seen... Extraskeletal osteosarcoma is a rare entity and case descriptions can be found throughout the literature mostly in the limbs and limb girdles... This may be related to the rarity of the lesion or, alternatively, that if a biopsy were to return osteoid in a large liver tumor, various more common tumors would be suspected including hepatoblastoma, hepatic teratoma, malignant mesenchymoma, carcinosarcoma, hepatic angiosarcoma, or other hepatic sarcoma... Moreover, when mixed epithelial components are present, the pattern of differentiation is essential to characterize the tumor... This would be impossible with only a needle biopsy... This case is notable for the young age at presentation (19 years old) and the prolonged disease-free survival she has experienced following surgery and adjuvant chemotherapy with multiagent chemotherapy.

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Coronal T2-weighted MR demonstrating the lobulated mass, predominantly hyperintense to liver. The calcified component is hypointense.
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Fig2: Coronal T2-weighted MR demonstrating the lobulated mass, predominantly hyperintense to liver. The calcified component is hypointense.

Mentions: To further evaluate the mass, a CT scan of the chest, abdomen, and pelvis was performed (Fig. 1), which showed a large heterogeneous mass occupying the left lobe of the liver with a 5-cm area of calcification in the anterior aspect. MRI demonstrated a single heterogeneously enhancing 15 × 10 × 13.8 cm lobulated mass inseparable from the left lobe of the liver (Fig. 2). The left portal vein was not visualized and there was no biliary dilatation. T1- and T2-weighted sequences showed a 5-cm area of signal hypointensity with multiple hypointense non-enhancing linear areas throughout the mass consistent with areas of calcification. A small amount of intraperitoneal free fluid was present. Staging chest and brain CT demonstrated no evidence for metastatic disease. Whole body Tc-99m MDP bone scan demonstrated no evidence of skeletal metastatic disease. The radiologic differential diagnosis includes sarcoma, including metastatic osteosarcoma, and fibrolamellar hepatocellular carcinoma.Figure 1


Primary hepatic osteosarcoma.

Nawabi A, Rath S, Nissen N, Forscher C, Colquhoun S, Lee J, Geller S, Wong A, Klein AS - J. Gastrointest. Surg. (2009)

Coronal T2-weighted MR demonstrating the lobulated mass, predominantly hyperintense to liver. The calcified component is hypointense.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710492&req=5

Fig2: Coronal T2-weighted MR demonstrating the lobulated mass, predominantly hyperintense to liver. The calcified component is hypointense.
Mentions: To further evaluate the mass, a CT scan of the chest, abdomen, and pelvis was performed (Fig. 1), which showed a large heterogeneous mass occupying the left lobe of the liver with a 5-cm area of calcification in the anterior aspect. MRI demonstrated a single heterogeneously enhancing 15 × 10 × 13.8 cm lobulated mass inseparable from the left lobe of the liver (Fig. 2). The left portal vein was not visualized and there was no biliary dilatation. T1- and T2-weighted sequences showed a 5-cm area of signal hypointensity with multiple hypointense non-enhancing linear areas throughout the mass consistent with areas of calcification. A small amount of intraperitoneal free fluid was present. Staging chest and brain CT demonstrated no evidence for metastatic disease. Whole body Tc-99m MDP bone scan demonstrated no evidence of skeletal metastatic disease. The radiologic differential diagnosis includes sarcoma, including metastatic osteosarcoma, and fibrolamellar hepatocellular carcinoma.Figure 1

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Cedars-Sinai Medical Center, 8635 W. 3rd Street, 590 West, Los Angeles, CA 90048, USA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Extraskeletal osteosarcoma (EOS) is a rare entity... Most human cases have been described in the soft tissues of the limb... Primary hepatic osteosarcoma is extremely uncommon with only seven cases reported in the world’s literature... The lesion extended across the falciform ligament into segment 4 of the liver... It was also adherent to, but did not invade, the stomach... She received a total of four courses of ifosfamide and two courses of cisplatin and doxorubicin with a cumulative dose of doxorubicin of 150 mg/m... The patient has been followed clinically as well as by serial CT imaging of her abdomen, pelvis, and chest... The spindle cells reacted with antibody directed against vimentin and there was no immunostaining for smooth muscle actin (SMA), S-100, desmin, epithelial membrane antigen (EMA), CD 57, or AE1/3... A high mitotic rate with greater than 80% staining for proliferative marker Ki-67 was seen... Extraskeletal osteosarcoma is a rare entity and case descriptions can be found throughout the literature mostly in the limbs and limb girdles... This may be related to the rarity of the lesion or, alternatively, that if a biopsy were to return osteoid in a large liver tumor, various more common tumors would be suspected including hepatoblastoma, hepatic teratoma, malignant mesenchymoma, carcinosarcoma, hepatic angiosarcoma, or other hepatic sarcoma... Moreover, when mixed epithelial components are present, the pattern of differentiation is essential to characterize the tumor... This would be impossible with only a needle biopsy... This case is notable for the young age at presentation (19 years old) and the prolonged disease-free survival she has experienced following surgery and adjuvant chemotherapy with multiagent chemotherapy.

Show MeSH
Related in: MedlinePlus