FEMORAL PAROSTEAL OSTEOSARCOMA METASTASE TO THE LUNG A Case Report
I Putu Gede Dharmawan* I Gede Eka Wiratnaya**
*Resident of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana University, Bali
** Staff of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana University, Bali
INTRODUCTION
Parosteal osteosarcoma (POS), or juxtacortical osteosarcoma, is a rare anatomical and clinical variant of osteosarcoma. POS is a slow-growing tumor which originates from the outer layer of the periosteum and represents 65% of surface osteosarcomas and approximately for 4,8% of all osteosarcomas. Unlike conventional osteosarcomas, it involves an older age group typically in the 3rd and 4th decades of life and shows a slight female predilection.
CASE AND METHODS
Male, 31 yo with chief complained pain on his right thigh since 2 years. The pain come and goes, getting worse in night. Patient also complained lump on his right knee since 8 months ago increasing size as time goes. Difficulty of breathing also felled by the patient since 3 weeks. Patient can not do normal activities without pain. Loss of body weight and fever also complained, chronic chough negative. History of trauma negative. No Family history who complained tumor. From physical examination we found mass at distal posteromedial side of right thigh without venectasis and hyperemia, skin contour is normal. Mass felt hard 10 cm x 10 cm fixed with surrounding tissue with ill defined margin without tenderness. AVN distal, active ROM of genu and ankle is normal. From X Ray we found bone tumor on the distal femur involve methaphyseal region with irregular pattern of mineralization and the periphery of the tumor and less radiodense than the center and we found tumors mass multiple discrete nodules that spread throughout the lung. Patient already done open biopsy on January 2014 at Sanglah Hospital with result Parosteal Osteosarcoma. Patient refused to take any action.
DISCUSSION
The tumor is usually located at the posterior aspect of the distal femur in about 70% of cases, followed by the proximal tibia and proximal humerus. Rare locations, including cranial, mandible, rib, clavicle, and tarsal bone, have also been reported. In our case femoral parosteal osteosarcoma metastase to the lung is a rare.
