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Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 353-354
Telangiectatic osteosarcoma: A case report


From the Honorary Asst Prof. Radio-Diagnosis IGMC and Mayo Hospital, Nagpur, India

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Keywords: Telangiectatic osteosarcoma - tibia

How to cite this article:
Phatak S V, Kolwadkar P K, Lawange A, Rajderkar D. Telangiectatic osteosarcoma: A case report. Indian J Radiol Imaging 2005;15:353-4

How to cite this URL:
Phatak S V, Kolwadkar P K, Lawange A, Rajderkar D. Telangiectatic osteosarcoma: A case report. Indian J Radiol Imaging [serial online] 2005 [cited 2018 Sep 25];15:353-4. Available from: http://www.ijri.org/text.asp?2005/15/3/353/29154

   Introduction Top


This aggressive variant of osteosarcoma [1],[2] is uncommon and is characterized by large blood filled cavities and thin septations within the tumor but scant production of osteoid tissue. Gender, age group and presenting symptoms are similar to those seen in-patients of conventional osteosarcoma [1] although presentation with pathological fracture is more commonly encountered in-patients with telangiectatic osteosarcoma [1],[2],[3]


   Case Report Top


A twenty one-year boy presented with a swelling and pain at left ankle for duration of three months. Swelling was gradually increasing in size. Radiograph showed a lytic lesion with pathological fracture and soft tissue swelling. CT scan shows subtle nodular mineralization peripherally and central low attenuation area. MR clearly identifies cystic areas as hyperintense signals on T2 W Images.Lesion is identified on isotope scan as focal hot spots in left lower tibia. Biopsy report was suggestive of telangiectatic osteosarcoma.


   Discussion Top


Telangiectatic osteosarcoma is an uncommon histopathologic subtype, Paget described it in 1854 as a medullary cancer of bone with extensive development of vessels and blood filled cysts. In 1903 Gaylord termed it as malignant bone aneurysm to describe a hemorrhagic, poorly ossified telangiectatic osteosarcoma. In 1922,Ewing was the first to classify telangiectatic osteosarcoma as a distinct histologic variant, characterized by a malignant osteoid forming sarcoma of bone with large blood filled vascular channels .It is more common in males. It can also occur as secondary lesion (in association with fibrous dysplasia or Pagets disease) or extraskeletal. Telangiectatic osteosarcoma has geographic bone destruction with a wide zone of transition. Marked aneurysmal dilatation of bone is also seen. [3] Another feature described in the literature is oblique parallel l striations seen in the shaft probably due to hypertrophy of veins of cortex, which cross the cortical bone in an oblique direction. [2] Metaphyseal lesions do extend into epiphysis. Aggressive periosteal reaction, cortical destruction associated with soft tissue mass are also common features. [1],[3],[4] the cystic consistency of telangiectatic osteosarcoma is reflected by its radiological appearance. Bone scintigraphy shows peripheral increased uptake with central osteopenia (donut sign) The CT attenuation of the central portion of the lesion is often lower than muscle. This central region also shows very high signal intensity on T2WI.At MR imaging haemorrhage is frequently observed as areas of high signal intensity, irrespective of MR pulse. Fluid-fluid levels are also demonstrated by MR imaging in approximately 90% of cases.Subtle osteoid formation is also frequently seen in the viable peripheral tumor.CT is best modality for detecting osteoid which appear as nodular calcific foci.[3]Role of sonography has its own limitations because it can not penetrate normal adult cortex in musculoskeletal system .But once the aggressive benign or malignant tumor has penetrated the cortex to produce a subperiosteal or extraosseous mass. This part of the tumor is well visualized on USG evaluation. The normal cortex of long bones is seen as relatively thick hyperechoic line with a well-defined smooth outer surface and posterior acoustic shadowing. Cortical destruction from medullary tumors particularly osteosarcoma causes discontinuity or marked irregularity of smooth hyperechoic line of normal cortex. Pathological fracture is identified as a break and step in the hyperechoic line of cortex with or without extraosseous tumor mass. Neurovascular bundle encasement or displacement caused by tumors with large extraosseous components in cases of tumors commonly arising in metaphysis of long bones is well shown with accuracy. Tumor matrix of lytic osteosarcoma has a heterogeneous echostructure commonly with well-defined hypoechoic areas corresponding to tumor necrosis. [5]

 
   References Top

1.Johan L Bloem,Herman M Kroon Osseous lesions:Telangiectatic osteosarcoma RCNA Vol 31,No.2,March 1993:  Back to cited text no. 1    
2.D vanel , S.Tcheng, G.Contesso, B.Zafrani, C.Kalifa, J.Dubousset, P.Kron The radiological appearance of Telangiectatic osteosarcoma Study of 14 cases Skeletal Radiology 1987;16:196-200.  Back to cited text no. 2    
3.Mark D Murphey, Mark R.Robbin, Gina A MCRae, Donald J Flemming, H Thomas Temple, Mark J Kransdorf The many faces of osteosarcoma Radiographics 1997; 17:1205-1231.  Back to cited text no. 3    
4.H.Gomes, B.Menanteau, D.Gaillard, C. Behar Telangiectatic Osteosarcoma Pediatr Radiol 1986;16:140-143.  Back to cited text no. 4    
5.A Saifuddin, SJD Burnett, R.Mitchell Ultrasonography of primary bone tumors Clinical Radiology 1998;53:239-246.  Back to cited text no. 5    

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Correspondence Address:
S V Phatak
Consultant Radiologist, Honorary Asst Prof. Radio-Diagnosis IGMC and Mayo Hospital, Nagpur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29154

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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]



 

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    Introduction
    Case Report
    Discussion
    References
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