Cahayadi S D, Antoro A, Swandika B
Department of Orthopaedic and Traumatology, Persahabatan General Hospital, Jalan Persahabatan Raya No.1, 13230 East Jakarta, Indonesia.
Int J Surg Case Rep. 2019;58:157-161. doi: 10.1016/j.ijscr.2019.04.017. Epub 2019 Apr 16.
Osteosarcoma is a malignant tumor of the bone. The treatment and prognosis have changed dramatically these days. Limb salvage surgery is a widely accepted alternative to amputation in patients with sarcoma. In most cases, the diagnosis of osteosarcoma is not difficult. We reported a rare location and a rare type of osteosarcoma case treated by elbow arthroplasty along with the challenging diagnostic and treatment.
We reported 46 years old female complained of pain on her left elbow for 5 months. An x-ray showed lytic lesion on the medial side of the elbow while the MRI examination suggested a malignant bone tumor in the epi-meta-diaphyseal of left ulnar bone. Core biopsy showed a Giant Cell containing lesion. The histology of resected tumor and Ki67 staining confirmed the diagnosis of giant cell-rich type osteosarcoma.
Giant cell rich osteosarcoma is an uncommon variant of osteosarcoma which characterized by an abundance of osteoclastic giant cells and lack of tumor osteoid. Involvement of forearm in conventional osteosarcoma is extremely rare. This was the epidemiologic reason why the osteosarcoma was not the first diagnosis of our case. Being a very rare location of the osteosarcoma, the management poses a special challenge. They are the surgical technique, which is not well described, and the implant that need to be custom made.
Giant cell rich osteosarcoma is difficult to diagnose because its histology and radiologic feature mimic a benign giant cell tumor.
骨肉瘤是一种骨恶性肿瘤。如今其治疗方法和预后已发生了巨大变化。保肢手术是肉瘤患者中广泛接受的截肢替代方案。在大多数情况下，骨肉瘤的诊断并不困难。我们报告了一例罕见部位和罕见类型的骨肉瘤病例，该病例采用肘关节置换术进行治疗，同时还面临着具有挑战性的诊断和治疗过程。
我们报告了一名46岁女性，她主诉左肘疼痛5个月。X线显示肘部内侧有溶骨性病变，而MRI检查提示左尺骨骨骺 - 干骺端有恶性骨肿瘤。核心活检显示病变中含有巨细胞。切除肿瘤的组织学检查和Ki67染色证实诊断为富含巨细胞型骨肉瘤。
富含巨细胞的骨肉瘤是骨肉瘤的一种罕见变体，其特征是有大量破骨细胞样巨细胞且缺乏肿瘤骨样组织。常规骨肉瘤累及前臂极为罕见。这就是该病例最初未诊断为骨肉瘤的流行病学原因。作为骨肉瘤非常罕见的发病部位，其治疗带来了特殊挑战。这些挑战包括未得到充分描述的手术技术以及需要定制的植入物。
富含巨细胞的骨肉瘤难以诊断，因为其组织学和放射学特征与良性巨细胞瘤相似。
