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Periosteal osteosarcoma

Summary

Periosteal osteosarcoma is the second most common surface osteosarcoma.

The tumor occurs in young adults, most commonly in the tibia and femur.
Patient's present with pain and a mass.
The lesion can be seen on the x-ray in the diaphyseal area of the bone, there may be erosion of the cortex with the tools of bone that are perpendicular to the surface.
Wide surgical removal and reconstruction are used to treat this tumor.
Complete Information on this Tumor
Introduction and Definition: 

Periosteal osteosarcoma accounts for one or 2% of all osteosarcomas.

Symptoms and Presentation: 

Patient present with local pain and a mass, that may be on the diaphysis and anterior cortex of the bone, especially when the tumor involved the tibia.

X-Ray Appearance and Advanced Imaging Findings: 
This lesion occurs on the surface along bones, most commonly the tibia and femur, usually in the diaphysis or metadiaphysis. The tumor may create a crater or depression in the cortex that had radiating mineralized striations. Marginal buttressing is frequently present. A relatively large soft tissue mass may occur. Generally, the medullary cavity is not involved until late.
Laboratory Findings: 
no contributory
Differential Diagnosis: 
Other surface lesions, including parosteal osteosarcoma, periosteal chondrosarcoma, sessile osteochondroma, Periosteal chondroma, myositis ossificans, osteomyelitis. Differentiation of this tumor from periosteal chondroma may be difficult.
Preferred Biopsy Technique for this Tumor: 
incisional
Histopathology findings: 
Microscopically, periosteal osteosarcoma appears to be chondroblastic, with a prominent cartilage component. The cartilage component is arranged lobules. There are focal areas of osteoid production, and bone spicules may be present that are arranged perpendicular to the shaft of the bone.
Treatment Options for this Tumor: 
Treatment of this tumor depends on the grade. High-grade lesions are treated the same as conventional osteosarcoma. Low-grade lesions have a low metastatic potential and are treated with wide surgical excision. Surgical treatment alone is associated with a 15% risk of metastasis. For this reason, adjuvant chemotherapy is sometimes recommended, especially for high-grade tumors.
Preferred Margin for this Tumor: 
Wide
Outcomes of Treatment and Prognosis: 
The prognosis for this tumor is generally better than that for conventional osteosarcoma. Long-term survival can be expected for approximately 80% of patients.