Clinical management of a challenging malignancy, osteoblastoma-like osteosarcoma: a report of four cases and a review of the literature

Abstract

Harzem Ozger,1 Bugra Alpan,1 Mehmet Salih Söylemez,2 Korhan Ozkan,3 Ahmet Salduz,4 Bilge Bilgic,5 Basak Kumbasar Sirin6 1Department of Orthopaedics and Traumatology, Maslak Acıbadem Hospital, Istanbul, 2Department of Orthopaedics and Traumatology, Bingöl State Hospital, Bingöl, 3Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medeniyet University, 4Department of Orthopaedics and Traumatology, 5Department of Pathology, Faculty of Medicine, Istanbul University, 6Department of Radiology, Maslak Acıbadem Hospital, Istanbul, Turkey Abstract: Osteoblastoma-like osteosarcoma, a rare form of osteosarcoma, is a malignant lesion associated with risks of both local recurrence and distant metastasis. The differential diagnosis of osteoblastoma-like osteosarcoma from osteoblastoma and aggressive osteoblastoma remains controversial and challenging. Previous studies suggest that these three types of tumor are distinct entities. However, working out a precise diagnosis may not always be possible immediately on the basis of initial clinical, radiological, and histopathological features. On the other hand, the importance of a correct diagnosis cannot be overemphasized since the treatment strategies change dramatically according to the nature of the lesion. In all of our cases, initial Tru-Cut biopsies revealed osteoblastic features with minimal atypia, but further biopsies confirmed malignancy. A high index of suspicion and considerable experience are prerequisites for accurate diagnosis in case of clinicopathological and radiological discordance. Keywords: osteoblastoma-like osteosarcoma, differential diagnosis, biopsy

Keywords

• Osteoblastoma-like osteosarcoma
• differential diagnosis
• biopsy