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Synchronous multifocal osteosarcoma with hypocalcemia.

Qin LF, Fang H, Qin LH, Guo XN, Peng D - Libyan J Med (2013)

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Laboratory tests revealed hypocalcaemia, elevated parathyroid hormone, alkaline phosphatase (ALP), and lactic dehydrogenase (LDH) (Table 1)... A lumbar intervertebral disc protrusion was also found by computed tomography (CT)... An x-ray of the lungs was normal... An open bone biopsy was performed on the bilateral distal femora and proximal tibiae, and four foci were found that exhibited mid-grade osteoblastic osteosarcoma (Fig. 4)... The rising level of serum parathyroid hormone (PTH) and 1, 25-dihydroxy vitamin D showed normal responses to prolonged hypocalcemia, and the patient was able to produce high levels of 1, 25-dihydroxy vitamin D despite low levels of 25-hydroxy vitamin D... The results of the BMD test showed a level 0.5% lower than that of adolescents of a similar age... It should be noted, however, that the serum calcium level was normal in this patient upon initial assessment, and hypocalcemia rapidly developed after patient care had commenced... The serum calcium did not reach a normal level until the patient had received a complete first cycle of neoadjuvant chemotherapy... In view of the elevated PTH and ALP levels, the severe and refractory hypocalcemia in this patient was most likely caused by rapid and continued deposition of calcium by the malignant osteoblasts into the tumor osteoid... Hypocalcemia in patients with osteosarcoma is extremely rare, and only four cases of MOS with hypocalcemia have been reported in the literature to date... Of these cases, one MOS patient with non-symptomatic hypocalcemia responded to calcitriol but did not respond to i.v. and oral calcium supplementation, two OS patients’ hypocalcemia appeared during treatment, and one MOS patient had obvious symptomatic hypocalcemia from the early phases of the disease... In summary, we have presented a rare case of synchronous MOS with hypocalcemia together with a current literature review... We conclude that it is still difficult to establish diagnosis standards for synchronous MOS, and targeted therapies should not be administered until sufficient biopsy and pathological findings are provided, since synchronous MOS has a similar presentation as metabolic bone diseases and significant clinical improvements from these therapies have not been achieved... Importantly, we suspect that hypocalcemia during MOS may be associated with the disease progression and poor prognosis.

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MRI of the left knee showing marked flakes and nodular long signals on T2-weighted MRI in the distal femur, proximal tibia, and even the osteoephysis.
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Figure 0003: MRI of the left knee showing marked flakes and nodular long signals on T2-weighted MRI in the distal femur, proximal tibia, and even the osteoephysis.

Mentions: On February 11, 2011, a 14-year-old male initially presented with pain in the right thigh muscle without trauma and was subsequently found to have purely osteosclerotic lesions of the skull, vertebrae, ribs, bilateral and nearly symmetric proximal humerus, pelvis, ilium, sacrum, proximal and distal femurs, and proximal tibiae (Figs. 1 and 2). The lesions were particularly evident in the right distal femur (Fig. 3). Laboratory tests revealed hypocalcaemia, elevated parathyroid hormone, alkaline phosphatase (ALP), and lactic dehydrogenase (LDH) (Table 1). A lumbar intervertebral disc protrusion was also found by computed tomography (CT).


Synchronous multifocal osteosarcoma with hypocalcemia.

Qin LF, Fang H, Qin LH, Guo XN, Peng D - Libyan J Med (2013)

MRI of the left knee showing marked flakes and nodular long signals on T2-weighted MRI in the distal femur, proximal tibia, and even the osteoephysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3585775&req=5

Figure 0003: MRI of the left knee showing marked flakes and nodular long signals on T2-weighted MRI in the distal femur, proximal tibia, and even the osteoephysis.
Mentions: On February 11, 2011, a 14-year-old male initially presented with pain in the right thigh muscle without trauma and was subsequently found to have purely osteosclerotic lesions of the skull, vertebrae, ribs, bilateral and nearly symmetric proximal humerus, pelvis, ilium, sacrum, proximal and distal femurs, and proximal tibiae (Figs. 1 and 2). The lesions were particularly evident in the right distal femur (Fig. 3). Laboratory tests revealed hypocalcaemia, elevated parathyroid hormone, alkaline phosphatase (ALP), and lactic dehydrogenase (LDH) (Table 1). A lumbar intervertebral disc protrusion was also found by computed tomography (CT).

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Laboratory tests revealed hypocalcaemia, elevated parathyroid hormone, alkaline phosphatase (ALP), and lactic dehydrogenase (LDH) (Table 1)... A lumbar intervertebral disc protrusion was also found by computed tomography (CT)... An x-ray of the lungs was normal... An open bone biopsy was performed on the bilateral distal femora and proximal tibiae, and four foci were found that exhibited mid-grade osteoblastic osteosarcoma (Fig. 4)... The rising level of serum parathyroid hormone (PTH) and 1, 25-dihydroxy vitamin D showed normal responses to prolonged hypocalcemia, and the patient was able to produce high levels of 1, 25-dihydroxy vitamin D despite low levels of 25-hydroxy vitamin D... The results of the BMD test showed a level 0.5% lower than that of adolescents of a similar age... It should be noted, however, that the serum calcium level was normal in this patient upon initial assessment, and hypocalcemia rapidly developed after patient care had commenced... The serum calcium did not reach a normal level until the patient had received a complete first cycle of neoadjuvant chemotherapy... In view of the elevated PTH and ALP levels, the severe and refractory hypocalcemia in this patient was most likely caused by rapid and continued deposition of calcium by the malignant osteoblasts into the tumor osteoid... Hypocalcemia in patients with osteosarcoma is extremely rare, and only four cases of MOS with hypocalcemia have been reported in the literature to date... Of these cases, one MOS patient with non-symptomatic hypocalcemia responded to calcitriol but did not respond to i.v. and oral calcium supplementation, two OS patients’ hypocalcemia appeared during treatment, and one MOS patient had obvious symptomatic hypocalcemia from the early phases of the disease... In summary, we have presented a rare case of synchronous MOS with hypocalcemia together with a current literature review... We conclude that it is still difficult to establish diagnosis standards for synchronous MOS, and targeted therapies should not be administered until sufficient biopsy and pathological findings are provided, since synchronous MOS has a similar presentation as metabolic bone diseases and significant clinical improvements from these therapies have not been achieved... Importantly, we suspect that hypocalcemia during MOS may be associated with the disease progression and poor prognosis.

Show MeSH