Management of Local Soft Tissue Recurrent Osteosarcoma After Wide Resection and Reconstruction with Megaprosthesis: A Case Report
Introduction: Limb salvage surgery involves all of the surgical methods to achieve the eradication of a malignant neoplasm and restoration of the limb with a satisfactory oncologic, functional, and cosmetic outcome. Rates of local recurrence are 4% to 10%. There is a chance of local recurrence from the contamination of biopsy path. Neoadjuvant chemotherapy has a guarding effect on managing neoplasm infiltration at the biopsy location.
Case Presentation: An 18 year old male experienced a new painless lump at his right anterior thigh with size about 5 cm in diameter since 5 months ago. Previously, he underwent limb salvage surgery with megaprosthesis about 6 months ago due to osteosarcoma at his right distal femur. He also got neoadjuvant and adjuvant chemotherapy for 6 cycles. Mass removal was done and 1.5 cm mass in diameter was found within quadriceps muscle with a soft consistency and well-defined border from the previous biopsy site that had not been resected. The specimen result was osteosarcoma surrounded by tumor-free tissue. Postoperatively, he still had the same range of motion function as before.
Conclusions: We need to consider the previously contaminated biopsy path that could lead to local recurrence. Factors that affect the prediction of the recurrent disease are the disease-free time period, location of recurrence and histological response to therapy and the capability to achieve total surgical removal. Tumor removal followed by the local radiation and chemotherapy is the preferred treatment for recurrence.
Ilaslan H, Schils J, Nageotte W, Lietman SA, Sundaram M. Clinical presentation and imaging of bone and soft-tissue sarcomas. Cleve Clin J Med. 2010;77(Suppl):S2–S7
Oliveira MP, Lima PM, da Silva HJ, de Mello RJ. Neoplasm seeding in biopsy tract of the musculoskeletal system: A systematic review. Acta Ortop Bras. 2014;22(2):106–110.
Oliveira MP, Lima PM, de Mello RJ. Tumor contamination in the biopsy path of primary malignant bone tumors. Rev Bras Ortop. 2015;47(5):631–637.
Liu PT, Valadez SD, Chivers S. Anatomically based guidelines for core needle biopsy of bone tumors: Implications for limb-sparing surgery. Radiographics. 2007;27(1):189-205.
Cannon SR, Dyson PHP. Relationship of the site of open biopsy of malignant bone tumours to local recurrence following resection and prosthetic replacement. J Bone Joint Surg Br. 1987;69:492.
Davies NM, Livesley PJ, Cannon SR. Recurrence of an osteosarcoma in a needle biopsy track. J Bone Joint Surg Br. 1993;75(6):977–978.
Mohana R, Faisham W, Zulmi W, Nawfar AS, Effat O, Salzihan MS. The incidence of malignant infiltration in the biopsy tract of osteosarcoma. Malays Orthop J. 2007;1:7–10.
Kaffenberger BH, Wakely PE, Jr, Mayerson JL. Local recurrence rate of fine-needle aspiration biopsy in primary high-grade sarcomas. J Surg Oncol. 2010;101(7):618–621
Saghieh S, Masrouha KZ, Musallam KM, et al. The risk of local recurrence along the core-needle biopsy tract in patients with bone sarcomas. Iowa Orthop J. 2010;30:80–83.
Loh AH, Navid F, Wang C, et al. Management of local recurrence of pediatric osteosarcoma following limb-sparing surgery. Ann Surg Oncol. 2014;21(6):1948–1955.
Nathan SS, Gorlick R, Bukata S. Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis. Cancer. 2006;107:1607-16.
Article MetricsAbstract view : 203 times
PDF - 97 times
- There are currently no refbacks.
Copyright (c) 2019 Indonesian Journal of Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.