A large osteosarcoma of distal humerus in a 13-year-old child - Case report

Abstract

Background: Massive skeletal tumours are rare and usually have a poor prognosis. Delayed presentation alters management and reduces survival, and is challenging to manage. Case report: A 13-year-old girl presented to our OPD with a 35cm X 35cm swelling over her left arm, which had been increasing in size for the past one year and an inability to use her left hand for the last three months. The patient had been bedridden for the past eight months and had stopped schooling. The distal vascularity of the limb was intact. However, there was a left radial nerve palsy. Radiographs revealed a sclerotic swelling with peripheral calcifications, which had destroyed the shaft of the humerus. The biopsy concluded the swelling to be a chondroblastic osteosarcoma. Neoadjuvant chemotherapy was given, and a forequarter amputation was performed. The patient was discharged on the fifth postoperative day and received adjuvant chemotherapy. Currently patient has resumed her daily activities and schooling, with no signs of recurrence. Conclusion: The gigantic size of such a tumour constitutes a rare presentation and calls for analysis and audit of the loopholes in our healthcare setup that might have led to this. Proper patient education and counselling regarding the disease and management options are essential. The size of the tumour isn't indicative of the presence or absence of metastasis, and a radical surgery such as an amputation may also drastically improve the quality of life of such patients.