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low-grade extraskeletal osteosarcoma

Monday 19 March 2018

LGESOS

Definition: Low-grade extraskeletal osteosarcoma (LGESOS) is an extremely rare soft tissue tumor, and patients with LGESOS tend to have a better prognosis. Extraskeletal osteosarcoma (ESOS) is a rare soft tissue sarcoma, typically characterized by a bone-producing neoplasm.

LGESOS represents an extremely rare but distinct form of extraskeletal osteosarcoma - ESOS.

It is important to recognize this tumor, because other neoplasms and tumor-like lesions may mimic the radiological and histological features of LGESOS.

Localization

- mediastinal low-grade extraskeletal osteosarcoma (mediastinal LGESOS)

Differential diagnosis

LGESOS needs to be discriminated from benign neoplasms, including :
- myositis ossificans
- ossifying lipoma
- ossifying fibromyxoid tumor
- classical ESOS
- parosteal osteosarcoma
- malignant mesenchymoma
- synovial sarcoma
- malignant fibrous histiocytoma.

LGESOS may be easily misdiagnosed as benign lesions due to mild cytological atypia in the tumor cells.

When fibrous lesions with bone-producing were found in the soft tissue, it should be carefully evaluate whether spindle cells with mature lineage, bone trabecula surrounded by osteoblasts, directly transitional phenomenon of fiber cells and bone trabecula, and invasion evidence were presented or not under light microscope.

LGESOS appears to represent a low-grade malignant tumor with better biologic behavior than classical ESOS.

Open references

- Low-grade extraskeletal osteosarcoma of the mediastinum: report of a case and review of literature. Int J Clin Exp Pathol. 2015; 8(3): 3279–3281.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440161/

- Large retroperitoneal low-grade extraskeletal osteosarcoma. Jaipuria J, Kumar A, Rao AS, Kataria SP. BMJ Case Rep. 2014 Mar 22;2014. pii: bcr-2014-203745. doi : 10.1136/bcr-2014-203745 PMID: 24658529

- Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature. Sabatier R, Bouvier C, de Pinieux G, Sarran A, Brenot-Rossi I, Pedeutour F, Chetaille B, Viens P, Weiller PJ, Bertucci F. BMC Cancer. 2010 Nov 24;10:645. doi : 10.1186/1471-2407-10-645 PMID: 21106072

Paywall References

- A low-grade extraskeletal osteosarcoma. Okada K, Ito H, Miyakoshi N, Sageshima M, Nishida J, Itoi E. Skeletal Radiol. 2003 Mar;32(3):165-9. PMID: 12605283

- Well-differentiated extraskeletal osteosarcoma. A soft-tissue homologue of parosteal osteosarcoma. Yi ES, Shmookler BM, Malawer MM, Sweet DE. Arch Pathol Lab Med. 1991 Sep;115(9):906-9. PMID: 1929787

- Radiation-Associated Low-Grade Extraskeletal Osteosarcoma of the Neck Following Treatment for Thyroid Cancer. Jones M, Chebib I, Deshpande V, Nielsen GP. Int J Surg Pathol. 2015 Aug;23(5):384-7. doi : 10.1177/1066896915587757 PMID: 26009571

- Umiker W, Jaffe HL. Ossifying fibrosarcoma (extraskeletal osteogenic sarcoma) of thigh muscle; report of a case with recurrence and widespread metastases more than four and a half years after excision. Ann Surg. 1953;138:795–800.

- Abramovici LC, Hytiroglou P, Klein RM, Karkavelas G, Drevelegas A, Panousi E, Steiner G. Well-differentiated extraskeletal osteosarcoma Report of 2 cases, 1 with dedifferentiation. Hum Pathol. 2005;36:439–43.

- Hishida T, Yoshida J, Nishimura M, Ishii G, Nakao M, Nagai K. Extraskeletal osteosarcoma arising in anterior mediastinum: brief report with a review of the literature. J Thorac Oncol. 2009;4:927–9.

- Sabatier R, Bouvier C, de Pinieux G, Sarran A, Brenot-Rossi I, Pedeutour F, Chetaille B, Viens P, Weiller PJ, Bertucci F. Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature. BMC Cancer. 2010;10:645.

- Arai H, Rino Y, Nishii T, Yukawa N, Wada N, Oshiro H, Ishida T, Nakaigawa N, Masuda M. Well-differentiated extraskeletal osteosarcoma arising from the retroperitoneum that recurred as anaplastic spindle cell sarcoma. Case Rep Med. 2010;2010:327591.