Khaw Y C, Wong J K, Sahran Y, Nor-Azman M Z, Faisham W I
Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Malays Orthop J. 2020 Nov;14(3):198-201. doi: 10.5704/MOJ.2011.034.
Telangiectatic osteosarcoma is a rare variant of osteosarcoma and can be easily misdiagnosed as aneurysmal bone cyst. We report an atypical case of iliac telangiectatic osteosarcoma in a young healthy female, who presents with painful slow growing expansile lytic septate lesion in the left hemipelvis, which is initially treated as aneurysmal bone cyst. The diagnosis of aneurysmal bone cyst is made after histopathological examination of core needle biopsy. Her condition became unstable and massive bleeding is noted at the lesion site after sclerosant injection. She undergoes emergency hemipelvectomy and eventually the biopsy turns up to be telangiectatic osteosarcoma. Our case highlights that core needle biopsy is not useful in making diagnosis for iliac telangiectatic carcinoma. Hence, an open biopsy should be carried out in our case. This case also emphasises on careful evaluation for malignancy which is mandatory because bleeding from pelvis after an unsuitable treatment can be grave, to the extent that major amputation hemipelvectomy is an option. Even though telangiectatic osteosarcoma has the same prognosis and treatment with conventional osteosarcoma, the outcome of delayed treatment for telangiectatic osteosarcoma is not good due to the dilemma in establishing an early correct diagnosis.
毛细血管扩张性骨肉瘤是骨肉瘤的一种罕见变异型，很容易被误诊为骨动脉瘤样囊肿。我们报告一例年轻健康女性的非典型髂骨毛细血管扩张性骨肉瘤病例，该患者左半骨盆出现疼痛性、生长缓慢的膨胀性溶骨性分隔病变，最初被当作骨动脉瘤样囊肿治疗。在对粗针活检组织进行病理检查后诊断为骨动脉瘤样囊肿。在注射硬化剂后，她的病情变得不稳定，病变部位出现大量出血。她接受了急诊半骨盆切除术，最终活检结果显示为毛细血管扩张性骨肉瘤。我们的病例表明，粗针活检对髂骨毛细血管扩张性骨肉瘤的诊断没有帮助。因此，在我们这个病例中应进行切开活检。该病例还强调了对恶性肿瘤进行仔细评估的必要性，因为不恰当治疗后骨盆出血可能很严重，甚至需要进行半骨盆切除术这样的大截肢手术。尽管毛细血管扩张性骨肉瘤与传统骨肉瘤的预后和治疗方法相同，但由于早期正确诊断存在困难，毛细血管扩张性骨肉瘤延迟治疗的效果不佳。
