FEMORAL PAROSTEAL OSTEOSARCOMA METASTASE TO THE LUNG

A Case Report
I Putu Gede Dharmawan* I Gede Eka Wiratnaya**
*Resident of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana
University, Bali
** Staff of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana
University, Bali
INTRODUCTION
Parosteal osteosarcoma (POS), or juxtacortical osteosarcoma, is a rare anatomical and clinical
variant of osteosarcoma. POS is a slow-growing tumor which originates from the outer layer of
the periosteum and represents 65% of surface osteosarcomas and approximately for 4,8% of all
osteosarcomas. Unlike conventional osteosarcomas, it involves an older age group typically in
the 3rd and 4th decades of life and shows a slight female predilection.
CASE AND METHODS
Male, 31 yo with chief complained pain on his right thigh since 2 years and also lump on his
right knee since 8 months ago increasing size as time goes.. The pain come and goes, getting
worse in night. Difficulty of breathing also felled by the patient since 3 weeks. Patient can not do
normal activities without pain. Loss of body weight and fever also complained, chronic chough
negative. History of trauma negative. No Family history who complained tumor. From physical
examination we found mass at distal posteromedial side of right thigh without venectasis and
hyperemia, skin contour is normal. Mass felt hard 10 cm x 10 cm fixed with surrounding tissue
with ill defined margin without tenderness. AVN distal, active ROM of genu and ankle is normal.
From X Ray we found bone tumor on the distal femur involve methaphyseal region with
irregular pattern of mineralization and the periphery of the tumor and less radiodense than the
center and we found tumors mass multiple discrete nodules that spread throughout the lung.
Patient already done open biopsy on January 2014 at Sanglah Hospital with result Parosteal
Osteosarcoma. Patient refused to take any action.
DISCUSSION
The tumor is usually located at the posterior aspect of the distal femur in about 70% of cases,
followed by the proximal tibia and proximal humerus. Rare locations, including cranial,
mandible, rib, clavicle, and tarsal bone, have also been reported. In our case femoral parosteal
osteosarcoma metastase to the lung is a rare.
KEYWORD
Parosteal Osteosarcoma, Metastase, Sanglah