Osteosarcoma - Signs, symptoms, diagnosis

Areas most affected are the distal femur, proximal tibia and proximal humerus, but virtually any bone can be affected. Not all are solitary osteosarcoma, several regions of the body may be affected bone-synchronous osteosarcoma. This type of osteosarcoma is rare, but when there affects children under 10.
Symptoms are present a few months before the patient is diagnosed. Pain symptom onset, especially exaggerated in the activity. Often there is a history of trauma. Fractures are not common pathological condition. Clinic patient may or may not accuse local swelling depending on the size and location of the tumor. Tumor that has spread to lungs and respiratory distress rarely shows such indicating extreme damage lungs. Metastases are rare elsewhere.
The physical examination includes:A palpable mass or not, may be sensitive or hot, skin vascularity adjacent tumor growth, pulatiiReduce motion-affected segment-Limfadenoaptia is unusual.
Osteosarcoma variants:Teleangieactic-osteosarcoma is considered more aggressive than the classic-Undifferentiated intraosseous osteosarcoma has a good prognosisGnat-osteosarcoma is rarely associated with metastatic extension, local recurrence is a problem butIntracortical osteosarcoma, the prognosis is uncertain because of the rarity-Secondary osteosarcoma and small cell are generally associated with negative prognosisWell-differentiated osteosarcoma is similar to the classic prognosticPeriostial-osteosarcoma is better than for classic-Good prognosis for osteosarcoma paraostialMulti-prognosis for osteosarcoma is cruel.
The diagnosis of osteosarcomaLaboratory studies:-Is important to assess organ function before chemotherapySerum lactic dehydrogenase is a prognostic test, with alkaline phosphatase-These patients with elevated serum markers of risk for pulmonary metastases-Full blood count and differential-Testing of liver, renal, electrolyte level, urinoanaliza.
Imaging Studies:Radiograph is critical in the initial evaluation of bone lesions.Radiographic aspects are variable. Most lesions show a mixture of lithic and sclerotic areas. Lesions rarely pure. Lesions appear aggressive edge as bad bite or occasionally demarcated cortical permeation with multiple holes. After chemotherapy surrounding bone can form a sheath around the tumor more clearly defined.The extension to soft tissue osteosarcoma is common and seen as a soft tissue mass. Near extension joints is difficult to distinguish from one epensament. Areas of cloud in the form of multiple sclerosis result from osteoid production and calcification.Periostiale reactions are observed once the tumor has spread to the cortex. These include a series of changes:-multilaminate Codman triangles, spiculate Solar and reactions that indicate an aggressive process.
Scanning X-ray tomography is useful when it is uncertain, especially in areas with complex anatomy. Presents more accurate picture of bone and soft tissue tumor. It is useful in flat bones that are difficult to assess changes periostiale.MRI is the procedure of choice for assessing local extension of disease due to contrast bone / bone meduva excellent. It is the best method of staging of osteosarcoma. It is useful in evaluating tumor extension into and extraosoase. Intraosseous extension characteristics are distances longitudinal bone containing the tumor, adjacent epiphyseal damage and the presence of metastases or not jump. Skip metastases are synchronous tumor seals that are anatomically separate from the primary lesion and appear on the same bone. Another joint secondary malignant deposits are called metastases transarticulare jump. These patients experience more frequent distant metastasis.
Histological examination: in general characteristic osteoid osteosarcoma is present in lesions, even in locations away from the bone. There are several different histologic types of osteosarcoma. Is the classic type encountered in childhood and adolescence and is subdivided into osteoblasts, chondroblasts and fibroblasts.Type teleangieactic space is filled with blood, at paraostial derived from bone cortex at the intermediate level is periostial and appears immediately under the periosteum in children.The differential diagnosis is made with the following conditions: Chondrosarcoma, Ewing's sarcoma, stress fracture, primitive neuroectodermal tumors, osteomyelitis, fibrosarcoma, benign tumors of bone and chondral, randomiosarcomul.