Osteosarcoma of the Hands and Feet: A Clinico-Pathologic Distinct Subgroup of OS?
Jakob K Anninga, Piero Picci, Herman M Kroon, Daniel Vanel, Pancras CW Hogendoorn. Leiden University Medical Center, Leiden, Netherlands; Istituto Ortopedico Rizzoli, Bologna, Italy
Background: Osteosarcoma (OS) of hands or feet represent less than 1% of all cases. From the sparse case reports in literature it seems that patients with these locations differ in clinical course, radiologic and/or pathological presentation, compared to the usual location of OS.
Design: In order to evaluate these individual observations, we studied a large cohort patients with OS in hand or foot, obtained from the merged Dutch Nation-wide Automated Pathological Archive (PALGA) and the Archives of the Netherlands Committee for Bone Tumours (NCBT) and that of the Istituto Ortopedica Rizzoli (IOR), Bologna, Italy, respectively. Clinical details, radiology and pathology reports were reviewed in most cases. The results of the patients were compared with published cases.
Results: Thirty-nine cases with OS localized in the hands (n=12) or foot (n=27) were identified in the data bases (1.7% of all OS). In concordance with 54 well documented individual case reports in literature of Hand OS another 54 such cases of Foot OS showed that patients in our data set were in the 4th-5th decade at diagnosis, older than usual. Male female ratio in these series was 2.0:1 vs 1.65:1 in the literature for OS of the foot, but OS of the hands thr M:F ratio was 1:1, different from the literature (M:F=1.38:1). The patient history was around 1year in this series, and pain and swelling were the most likely presenting symptom of OS in both hands and feet. In our series, more OS were located in the metacarpals (58%) than in the phalanges (25%) of the hands, similar as in the literature. In the foot, the tarsal and metatarsal bones were in 56% and 33% involved, which was more or less like was found in the literature. The phalanges were affected in 11%. Histologically, 30% of OS in this series were low grade (nearly all LG central OS), whereas in the literature 20% (foot) - 24%(hand) were low grade OS. Although the most frequent subtype was the (high-grade) osteoblastic variant, but 8%-15% of the high grade OS were of the unconventional variants. Using standard OS-chemotherapy protocols for high grade OS in combination with adequate surgery, overall survival in the our series was > 70%.
Conclusions: OS in hand and feet is rare and represent < 1% of all OS, have different and peculiar clinical and histological features but should be approached similar like high grade OS in more common sites.
Category: Bone & Soft Tissue
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 5, Tuesday Morning