The ultrastructure of small-cell osteosarcoma, with a review of the light microscopy and differential diagnosis.

Small-cell osteosarcoma is a rare form of osteosarcoma and often poses difficulty in differential diagnosis when tissue samples do not include any diagnostic osteoid. By light microscopy, it may be difficult to distinguish small-cell osteosarcoma from other small-cell neoplasms, especially Ewing's sarcoma and mesenchymal chondrosarcoma. Relatively little has been reported about the ultrastructural characteristics of small-cell osteosarcoma, whereas electron microscopic examination has proven very useful in the diagnosis of most other small-cell neoplasms. We have studied four proven small-cell osteosarcomas in detail at the electron microscopic level and found their common features to be a high nucleocytoplasmic ratio, poorly differentiated cytoplasm, numerous free ribosomes and mitochondria as the next most prevalent organelle, small junctions, and envelopment of individual and groups of cells by matrix. Beyond these characteristics, cytoplasmic organelles and nuclear features varied, and no single pathognomonic ultrastructural picture was observed. However, within the range of possible ultrastructure of small-cell osteosarcoma, most small-cell neoplasms can be ruled out. Only certain examples of Ewing's sarcoma and mesenchymal chondrosarcoma may be indistinguishable from it when osteoid is not present in the sample.