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OSTEOSARCOMA
Edited by Manish Agarwal
Osteosarcoma
Edited by Manish Agarwal
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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First published April, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechopen.com
Osteosarcoma, Edited by Manish Agarwal
p. cm.
ISBN 978-953-51-0506-0
Contents
Preface VII
Part 1 Osteosarcoma Workup 1
Chapter 1 Histopathology and Molecular Pathology
of Bone and Extraskeletal Osteosarcomas 3
Helen Trihia and Christos Valavanis
Chapter 2 Imaging Osteosarcoma 41
Ali Nawaz Khan, Durr-e-Sabih,
Klaus L. Irion, Hamdan AL-Jahdali and
Koteyar Shyam Sunder Radha Krishna
Part 2 Osteosarcoma Treatment 83
Chapter 3 Misdiagnosis and Mistreatment for Osteosarcoma:
Analysis of Cause and Its Strategy 85
Yao Yang and Lin Feng
Chapter 4 Chemotherapy in Osteosarcoma 93
Kapadia Asha, Almel Sachin
and Shaikh Muzammil
Chapter 5 Limb Salvage for Osteosarcoma:
Current Status with a Review of Literature 109
Manish G. Agarwal and Prakash Nayak
Part 3 Osteosarcoma Research 137
Chapter 6 Bone Formation Deregulations Are
the Oncogenesis Keys in Osteosarcomas 139
Natacha Entz-Werlé
Chapter 7 The Retinoblastoma Protein in Osteosarcomagenesis 159
Elizabeth Kong and Philip W. Hinds
Preface
Osteosarcoma, is the most common malignant primary bone tumor. Though high
grade and potentially lethal, it is highly curable. Though a rare cancer, it
predominantly affects children and young adults and being highly curable, the
treatment strategy has permanent impact on the life of the patient. A plateau has been
reached in its outcome but a lot of research is now being aimed at molecular level to
find potential targets for treatment. The dissemination of knowledge coupled with
availability of affordable chemotherapeutic drugs and prosthesis have improved the
outcomes even in the developing world. The necessity of providing low cost treatment
has resulted in innovation in strategy and surgical approach.
Osteosarcoma is to orthopaedic oncology what tuberculosis is to infection. Both have
varied spectrum of presentation and can mimic a host of conditions. This book is not
meant to be a treatise on osteosarcoma. As the title suggests, it is a fresh look at this
disease with an aim to update the existing knowledge on etiology, pathology and
workup and to provide a look at the chemotherapeutic and surgical strategy.
Importance has also been given to the new research which could potentially change
the systemic treatment.
What is also different about this book is that it is online, open access and has been
done in a short turnaround time keeping the information very current at time of
publication. The authors have published in this field before and many have experience
of seeing hundreds of osteosarcomas. This book should be useful to clinicians,
researchers as well as students with an interest in the field of osteosarcoma.
Manish Agarwal
Hinduja Hospital, Mumbai,
India
Part 1
Osteosarcoma Workup
[...]... first published by Trihia et al, Acta Cytologica, 2007;51:443-450) 9 10 Osteosarcoma 2.5 Secondary osteosarcomas Secondary osteosarcomas are bone forming sarcomas occurring in bones that are affected by preexisting abnormalities, the most common being Paget disease and radiation change 2.5.1 Paget osteosarcoma Incidence of sarcomatous change in Paget disease is estimated to 0.7-0.95%, with osteosarcomas... correct diagnosis 2.7 Periosteal osteosarcoma It accounts for less than 2% of all osteosarcomas, more common than high grade surface osteosarcoma, but about one third as common as parosteal osteosarcoma (Unni et al, 1976) Unlike parosteal osteosarcoma, which extends from the cortex like a bony knob, periosteal osteosarcoma tightly encases the bone, like a glove Unlike other osteosarcomas, it tends to involve... et al., 2001) 22 Osteosarcoma 5.4.3 Small cell osteosarcoma No specific cytogenetic abnormalities have been detected in small cell osteosarcoma Small cell osteosarcoma can be distinguished from Ewing sarcoma by the presence of neoplastic bone and the absence of the t(11:22) translocation or one of its variants 5.4.4 Low grade central osteosarcoma Low grade central (intramedullary) osteosarcoma show... Telangiectatic osteosarcoma When first recognized, telangiectatic osteosarcoma was considered a distinct clinical and pathologic entity (Gaylord, 1903) On the basis of subsequent findings, telangiectatic osteosarcoma was considered a variant of osteosarcoma (Ewing, 1922, 1939) Histopathology and Molecular Pathology of Bone and Extraskeletal Osteosarcomas 7 It is rare, less than 4% of all cases of osteosarcomas... multifocal osteosarcomas have been reported (Ackermann, 1948, Amstutz, 1969, Laurent et al, 1973) According to the mode of growth, osteosarcomas are subdivided into intramedullary and surface osteosarcomas Intramedullary osteosarcomas are further subdivided into typical intramedullary, telangiectatic and highly differentiated Surface osteosarcomas are subdivided into periosteal and parosteal osteosarcomas... treatment can alter tumour appearance In addition, osteosarcoma may be of any histologic grade Some contain highly pleomorphic cells and abundant mitotic figures, whereas others may be difficult to differentiate from benign neoplasms 6 Osteosarcoma 2.1.1 Osteoblastic osteosarcoma Conventional osteosarcoma is usually of the osteoblastic type In osteoblastic osteosarcoma the predominant matrix is bone and/or... benign tumour or non-bone forming malignancy (Cahan et al, 1948) Histologically, high grade osteosarcomas predominate Many of the reported cases of osteosarcoma arising in fibrous dysplasia have also been complicated by radiation therapy 2.5.3 Osteosarcomas in other benign precursors Other rare instances of secondary osteosarcomas have included cases arising in association with bone infarcts, endoprostheses... approach, based principally on histologic classification Under this system, central low grade osteosarcoma and parosteal osteosarcoma are considered Grade 1 sarcomas, with periosteal osteosarcoma considered Grade 2, and all other osteosarcomas considered Grade 3 (Dorfman et al, 1998, 2002) The exact cause of osteosarcoma is unknown The best known causative association environmental risk factor is exposure... chondroblastic differentiation may be confused with periosteal osteosarcoma The degree of cytologic atypia is greater in high grade surface osteosarcoma and the tumours generally show larger spindle cell areas Finally, unlike dedifferentiated parosteal osteosarcomas, low grade regions are not found in high grade surface osteosarcomas 12 Osteosarcoma Cortical destruction and invasion into the medullary... techniques have a limited role in diagnosing osteosarcoma, as the tumour is largely recognized by its morphologic features Because of the many varieties of osteosarcoma, diverse tumours are considered in its differential diagnosis 16 Osteosarcoma Currently, immunohistochemistry has limited application in the differential diagnosis of primary bone tumors In general, osteosarcoma has a broad immunoprofile . OSTEOSARCOMA
Edited by Manish Agarwal
Osteosarcoma
Edited by Manish Agarwal
Published by InTech
Janeza. orders@intechopen.com
Osteosarcoma, Edited by Manish Agarwal
p. cm.
ISBN 978-953-51-0506-0
Contents
Preface VII
Part 1 Osteosarcoma Workup
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