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Benign Lesions in Cancer Patients

CASE 2. Unusual Association of Osteosarcoma and Sarcoidosis

Akita University School of Medicine, Akita, Japan

A 29-year-old Japanese woman first noticed pain around her left knee in May 1997. The pain gradually increased, and the patient visited our outpatient clinic in June 1998. Radiographs showed an osteolytic lesion in the distal femur with irregularly distributed mineralization (Fig 1A). In the lateral view, periosteal reaction of the posterior part of the distal femur and a partially mineralized soft tissue mass were observed (Fig 1B). A biopsy specimen contained proliferations of cartilaginous tissue and spindle cells with marked nuclear atypia. Scattered osteoid formation was also observed. A diagnosis of osteosarcoma of the left distal femur was made. The patient began a 12-week course of preoperative chemotherapy including high-dose methotrexate (10 g/m²) with leucovorin rescue, doxorubicin hydrochloride (30 mg/m² x 2 days), and cisplatinum (100 mg/m²). She underwent a wide excision with replacement by a metal prosthesis in December 1998. The histologic evaluation of chemotherapy effect was poor. She received postoperative chemotherapy including high-dose methotrexate with leucovorin rescue, doxorubicin hydrochloride, cisplatinum, and ifosfamide (2 g/m² x 4 days) for 6 months. In June 2003, chest radiographs and computed tomography scans (Fig 2) showed enlarged bilateral hilar and paratracheal lymph nodes. Her serum angiotensin-converting enzyme was within the normal range (11.5 U/L; normal range, 8.3 to 21.4 U/L). Gallium scintigram showed an increased uptake in bilateral hilar regions. Clinical and radiological patterns suggested the possibility of metastatic osteosarcoma, though most metastases from osteosarcoma are hematogenous. A biopsy specimen taken by thoracoscopy showed diffuse noncaseating granulomas (Figs 3 and 4). Sarcoidosis associated with osteosarcoma was diagnosed, but no other lesion was detected in a further systemic investigation. The chest computed tomography scan has remained unchanged. The patient is healthy 5 years 3 months after surgery, without any evidence of local recurrence or distant metastasis.

View larger version (109K): [in this window] [in a new window]   Fig 1.

View larger version (104K): [in this window] [in a new window]   Fig 2.

View larger version (136K): [in this window] [in a new window]   Fig 3.

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Authors’ Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Okada, K. Articles by Itoi, E. Search for Related Content PubMed PubMed Citation Articles by Okada, K. Articles by Itoi, E. Social Bookmarking                            What's this?