The common sites of osteosarcoma

Written by Wang Cheng Lin
Orthopedics
Updated on December 27, 2024
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Osteosarcoma commonly occurs in the long tubular bones of the limbs, such as the femur, tibia, and humerus, especially near the joints of these long bones where the incidence is highest. In children, the distal femur and proximal tibia account for about three-quarters of all bone tumors. Osteosarcoma can also occur in the proximal humerus, the spine, and the ribs, although it is less common in these locations. The most frequent sites remain the long tubular bones in the limbs.

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Written by Wang Cheng Lin
Orthopedics
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How to diagnose osteosarcoma?

For the examination of osteosarcoma, the first step is to take an X-ray, which can show changes in the bone quality. At the same time, it is necessary to perform a CT scan or MRI to clarify the nature of this bone tumor and its extent, or whether there is any distant metastasis. The third method is a nuclear bone scan, which mainly detects whether there are any early distant metastatic lesions. Of course, in clinical practice, the gold standard for diagnosing osteosarcoma relies on the examination of living tissue. That is, to perform a surgery, carry out a minor operation to obtain a little tissue from the bone tumor, and then send it for pathological examination to determine the nature of the tumor. This is the gold standard for diagnosing osteosarcoma.

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Written by Wang Cheng Lin
Orthopedics
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What tests are done to diagnose osteosarcoma?

The most accurate diagnostic method for osteosarcoma is biopsy, where live tissue is extracted and sent for pathological examination. The positive rate of this method can reach over 90%. Besides biopsy, there are several other methods to examine such conditions. For example, X-rays can be taken to observe significant damage to the bone structure. Secondly, CT scans and MRI can be used to determine whether the bone tumor has infiltrated surrounding tissues. MRI can also detect if there are metastases to organs outside the lungs. The third method is radionuclide bone scanning, which primarily aims to check for distant metastases of osteosarcoma.

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Written by Guan Yu Hua
Orthopedic Surgery
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Characteristics of Osteosarcoma

Osteosarcoma is a malignant tumor of the bone that primarily occurs in adolescents and young adults, commonly found at the metaphyseal ends of long bones. For example, it may occur at the distal end of the tibia, the distal end of the femur, or the metaphyseal end of the humerus. Clinically, the main symptom is pain, which is persistent and more noticeable at night, accompanied by a local mass, limited movement, increased local skin temperature, distended veins, and general symptoms such as weight loss and even cachexia. Some patients may experience pathological fractures. Often, there are no symptoms in the early stages, and by the time it is detected, it is usually in an intermediate or advanced stage. Radiographic examination typically shows a Codman's triangle or sunburst pattern. Early detection and treatment are crucial. The usual treatment choice is surgical, such as deactivation and reimplantation, or limb-salvage surgery with prosthetic implantation. Additionally, amputation followed by extensive chemotherapy is another option. With recent advances in chemotherapy, there has been significant improvement in life extension.

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osteosarcoma X-ray presentation

The variations in the X-ray appearance of osteosarcoma are quite large, but the basic characteristics are a mix of osteolytic destruction and pure bony changes. In most cases, besides the mixed changes, there is also destruction of the bone cortex and invasion of soft tissues, with visible periosteal reaction. The epiphysis has a certain blocking effect on the tumor, hence it rarely crosses the epiphyseal line. On the X-ray, changes indicative of skip metastasis can be seen, along with typical Codman's triangle or sunburst patterns. Beneath the periosteum, there are fine, needle-like sunburst radiating changes, which are fairly typical radiographic changes of osteosarcoma and are generally used to diagnose the condition.

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Why does osteosarcoma not hurt?

Osteosarcoma usually presents with pain, which is often severe, persistent, and most pronounced at night. The local skin temperature may also increase, accompanied by venous obstruction. It is a malignant tumor of the bone, most commonly located near the proximal part of the tibia or the distal part of the femur. The main symptom is pain, and a definite diagnosis can be made through radiographic examination, such as sunlight exposure, Codman's triangle, etc. In its early stages, osteosarcoma can metastasize. If there is no pain, it may be due to individual variations in the disease. However, the first symptoms of malignant bone tumors are usually pain and a palpable mass. Radiographic examinations will show changes. If osteosarcoma is confirmed and there is no pain, it could be related to the disease not having progressed to a more severe stage, possibly indicating an early stage. Early aggressive surgical treatment is recommended, such as limb-sparing surgery, devitalization and reimplantation, or prosthetic implantation. Another option is amputation. Osteosarcoma has a relatively high chance of metastasizing to the lungs; therefore, early surgery, early diagnosis, and rapid chemotherapy are essential, as these can significantly increase the five-year survival rate.