1. Features: The tumor grows near cortical bone with low malignancy and slow growth.
2. Age of onset: about 30 years old.
3. location: behind the lower end of femur >; Tibia and upper humerus
4. The naked eye: the boundary is clear and hard, which can invade the cortex and involve the medullary cavity. The tumor adheres to/surrounds the bone surface and has a gap with the bone cortex.
5. Microscopically, the tumor tissue structure is dense, mainly fibrous tissue, with a large number of mature trabeculae and spindle tumor cells distributed around it. Tumor cells are well differentiated and mitosis is rare.
6. Pro-table:
(1) Early asymptomatic, gradually swelling, mild pain. The lump is fixed, inactive, and tenderness is not obvious.
②x-ray: Dense mass, lobulated/nodular with clear edge. There is always a zona pellucida between tumor and bone, and there is no periosteal reaction.
③CT: There is a large shadow of bone density outside the bone, with a wide base, which tends to wrap the diaphysis, and can show whether the cortical bone and medullary cavity are invaded.
7. Treatment: tumor resection is the main method, and extensive resection should be adopted. Incomplete resection is easy to recur, and multiple recurrences often require amputation. It is insensitive to radiotherapy and chemotherapy, and its prognosis is better than that of ordinary osteosarcoma.
Secondly, telangiectatic osteosarcoma.
1. Features: high degree of malignancy, rapid progress of the disease, and more pathological fractures.
2. Pathology: There are dilated blood sinuses in the tumor, which are interconnected and have different sizes. Malignant cells and multinucleated cells are distributed in fibrous septa and surrounding areas, accompanied by mitosis and a small amount of bone-like tissue.
3. Pro-table:
①X-ray: Osteolytic destruction is the main feature, the cortical bone is thinned, showing infiltration progress, and the boundary is unclear, which can penetrate the cortical bone to form soft tissue tumors and may have periosteal reaction.
②CT: Expansive osteolytic destruction, unclear boundary, destruction of bone cortex and formation of soft tissue mass.
4. Treatment: amputation+chemotherapy; Unfavorable forecast
Third, round cell bone tumor
1. Pathology: small round cells are the main ones, and tumor osteoid tissue, glycogen staining and S- 100 immunohistochemistry (-) can also be seen.
2. Pro-face: mainly swelling and pain; X-ray: osteolytic destruction, involving bone cortex and medullary cavity, blurred margin, periosteal reaction and soft tissue mass.
3. Treatment: amputation+preoperative and postoperative adjuvant chemotherapy; The prognosis is very poor.
Four. Periosteal osteosarcoma
1. Features: One of the subtypes of paraosseous osteosarcoma, the lesions mainly occur in periosteum and bone cortex, and the tumor is closely connected with bone cortex, which can invade soft tissue and form soft tissue masses.
2. Microscopically, chondroid tissue showed chondrosarcoma-like changes, and atypical spindle cells formed bone-like tissue.
3. Clinical manifestations: Young people are more common, mainly lumps and pains, mostly in tibia and femur.
①X-ray: The tumor is located on the surface of bone cortex, with calcification and osteogenic changes, and the surface of the affected bone cortex is damaged to form defects, with Cordman triangle and radial shadows.
②CT/MRI: To understand the bone destruction, tumor range and bone marrow cavity invasion.
4. Treatment: extensive local excision or amputation, preoperative and postoperative adjuvant chemotherapy.
Five, intramedullary low-grade malignant osteosarcoma
1. Pathological features: well-differentiated, tumor cell atypia is not obvious, tumor giant cells are few, mitosis is rare, and well-differentiated osteoid tissue can be seen.
2. Clinical symptoms: the onset is slow, and the main symptoms are pain and slowly increasing mass. X-ray: local osteolytic destruction, bone cortex thinning, swelling and clear boundary.
3. Treatment: extensive resection/amputation+chemotherapy, with good prognosis.
6. Multiple osteosarcoma: multiple osteosarcoma and bony osteosarcoma, with typical osteosarcoma on the surface; Treatment: amputation+chemotherapy
Seven, radiation osteosarcoma: induced after radiotherapy, the surface of the original radiotherapy pain, swelling, pathological fracture. X-ray: sclerosing osteosarcoma, soft tissue mass.
Paget sarcoma: the course of disease is long, and it is easy to occur in the elderly. The clinical manifestations are gradually increasing swelling and pain. X-ray showed obvious bone destruction, and amputation was the main treatment.