Chondroblsatic

Osteosarcoma
A case
Study

UoB:
07029511
Objectives:
• To critically analyze the value of
each imaging examination in the
management and diagnosis of a
patient who presented
symptomatically.
• To discuses the decision making
process in the patient imaging
pathways for the diagnosis and the
management of the patient.
Confidentiality
• Anonymisation
• Patient’s consent to disclosing the information
• Only necessary information
• The Confidentiality model
(Confidentiality: NHS Code of Practice 2003)
Presenting Complaints

• Fifteen years old male patient

• Swelling in posterior region of the scalp
• Outside diagnosis was osteosarcoma,
• Primary lesion in skull
• Disease recurrence
Clinical History
• Patient underwent surgery in September 2009
• Excision of the mass done
• No histopathology of the of the excised mass
was performed.
• Another open excision biopsy was done on local
recurrence of the disease.
• This time histopathology was performed
• Diagnosis was osteosarcoma.
Diagnostic Tests
• Different diagnostic tests were
ordered to confirm the diagnosis
• These tests includes CT head, chest
radiography, and bone scintigraphy
• Pathology slides of the biopsy
sample were reviewed by an
oncology pathologist
Results of the diagnostic tests
Diagnostic tests Results
Chest Radiograph Clear
CT Head Appearances remain
suspicious for residual
tumour
Bone scintigraphy Bony pathology at
occipital bone.
-ive for metastases
Review of Pathology Suggestive of
slides chondroblastic
osteosarcoma
CT Head
Diagnosis

• Confirmed Chondrblastic Osteosarcoma

• Primary lesion in skull
Staging and toxicity workup
• Different imaging and pathology test
• Which includes
• CT thorax
• MRI Brain
• MUGA
• Creatinine Clearance
• Baseline organ function tests
Results of the test
Tests Results
CT Thorax Normal
MRI Brain Predominantly large extra
cranial occipital mass.
Small intracranial extradural
enhancement.
Skull Radiographs Soft tissue swelling in occiput
Periosteal reaction in outer-
table dominantly
MUGA LVEF = 68%.
Cont…
Pathology Tests Results

Baseline organ function Within normal limits

tests

Creatinine clearance Slightly raised * 131

ml/min
Patient Management
• Chemotherapy was planned due to
classically resistant nature of the tumour
towards radiotherapy
• Surgery was considered as an option
• Orthopaedic surgeon’s opinion
• Discussed in multidisciplinary meeting
Multidisciplinary teams

• Multidisciplinary team meetings play a

very significant role in patient
management
• Patient was presented into
sarcoma MDT meeting
• later, he was presented in Neurology
MDT meeting to decide patient
management
Justification of imaging studies

• Role of the imaging modalities

– Diagnostic workup
– Staging and toxicity workup
• Advantages
• Drawbacks
• Impact on patient management
• As Low As reasonably Practicable
(IRMR, 2000)
Plain film Radiography

• To establish the diagnosis

• Facilitate to narrow down the differential
diagnosis
• Location of the bone
• New bone formation
CT Thorax and CT head

• Important to detect micro lesion

• Easily detect the lesions less than three
centimetres
• Retrocardial nodule can not be missed
• Cross sectional imaging provides
CT Head

• Advantage
MRI Brain
References:
• Confidentiality: NHS Code of Practice
(2003)
• (IRMR, 2000)
You can ask a Question!!