Case Author(s): Brigid Gordon, M.D. and Barry A. Siegel M.D. , 07/05/96 . Rating: #D3, #Q5
Diagnosis: Osteosarcoma with regional nodal metastatic disease
Brief history:
17-year old girl with biopsy-proved left
maxillary osteosarcoma. Bone scintigraphy requested
to evaluate for metastatic disease.
Images:
Selected views from whole-body bone scintigraphy (images from the lower half of the body were normal.
View main image(bs) in a separate image viewer
View second image(bs).
Additional views of the neck with chin up. Why might you want these?
Full history/Diagnosis is available below
Diagnosis: Osteosarcoma with regional nodal metastatic disease
Full history:
17-year old girl with biopsy-proved left
maxillary osteosarcoma. Bone scintigraphy requested
to evaluate for metastatic disease.
Radiopharmaceutical:
Tc-99m MDP i.v.
Findings:
Bone scintigraphy demonstrates
markedly increased uptake of tracer in the left
maxilla, consistent with known osteosarcoma. There
is also a focus of increased uptake in the left neck in
the soft tissues. A radiograph of the neck demonstrated
a focal calcification in the soft tissues of the left neck.
Discussion:
Osteosarcoma affecting the
craniofacial bones occurs infrequently, constituting
only 8.6% of total osteosarcomas in Dahlin's and
Unni's series published in 1986. Review of
craniofacial osteosarcomas in 1988 from MD Anderson
Hospital in Texas found 26 total osteosarcomas of the
cranial and facial bones with 11 originating in the
alveolar ridge of the maxilla. In their series, the
average age was 35 years with a male/female ratio of
7:4. Painless local swelling was the presenting
symptom in the majority of patients. Cervical
lymphadenopathy did not occur in this series, based on review of
imaging studies including radiographs, CT scans, and
MRI imaging. Another recent review by Vege et al.
from India in 1991 identified 34 cases of craniofacial
osteosarcoma of which 32% were centered in the
maxillary bone. They found that radical surgery was
the best treatment because morbidity and mortality
were increased predominantly by local recurrence of
the tumor after initial incomplete resection. This
included recurrence in local lymph nodes in the neck.
Metastases to other internal organs by craniofacial
osteosarcomas were rare.
References:
1) Craniofacial Osteosarcomas. Lee et al. AJNR 1988; 9:379.
2) Craniofacial Osteosarcomas. Vege et al. JCFM 1991; 19:90.
Followup:
After bone scintigraphy
identified a focus of activity in the soft tissues of the
neck, the patient underwent a CT scan, which
demonstrated a calcified lymph node in the left
posterior cervical triangle. Needle localization followed by
surgical biopsy of this lymph node identified
metastatic osteosarcoma.
Major teaching point(s):
Increased uptake of tracer in
lymph nodes rarely represents
metastatic disease with dystrophic calcification or ossification. Calcification
in lymph nodes is more commonly due to old inflammatory/granulomatous
disease.
ACR Codes and Keywords:
References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Neoplasm, Neoplastic-like condition)
Search for similar cases.
Edit this case
Add comments about this case
Return to the Teaching File home page.
Case number: bs061
Copyright by Wash U MO
