Medires Publishers - Article Full Text

Abstract

Osteosarcoma is an primary bone cancer that typically occurs during adolescence and young adulthood. Secondary os- teosarcoma following orthopedic implantation is extremely uncommon. We report an implant-related osteosarcoma in an adult patient who underwent internal fixation of an intertrochanteric fracture. The case underscores the requirement for long-term implant site surveillance for the early detection of neoplastic change.

Introduction

Osteosarcoma is characterized by the production of osteoid by malignant mesenchymal cells. While the etiologic is very idiopathic, secondary osteosarcoma can occur secondary to previous radiation, chronic bone disease, or rarely, met- al implants. Implant-associated malignancy is not well un- derstood, and only a few cases have been described in the whole world. We are reporting such a rare case from UP- UMS, Saifai.

Case Presentation

A 59-year-old male patient presented to the Radiotherapy OPD of UPUMS, Saifai with the history of progressive swelling and pain for three months over Left thigh & Hip joint. He had a history of a femoral shaft fracture years ago, which was managed with internal fixation of a titanium intramedullary nail in a private hospital.
Clinical examination showed a hard, soft tissue mass over the distal femur with restricted right knee range of motion. No infection signs were observed. Radiological assessment (X-ray, MRI) showed periprosthetic destructive lesion with periosteal reaction and soft tissue extension, indicative of a neoplastic process.
Lesion biopsy confirmed the diagnosis of high-grade conventional osteosarcoma. Treatment was given.
Postoperatively, the patient was to the Department of Radiotherapy and Department of Biochemistry at UPUMS, Saifai, where he received adjuvant chemotherapy (cisplatin and doxorubicin-based regimen).

Figure1: biochemical parameters Osteosarcoma Case

Here’s the graph comparing the patient’s biochemical parameters to the reference midpoint values. It shows that:

•    RBS, SGPT, Creatinine, and Uric Acid are significantly elevated.
•    Serum Calcium is below normal.

Corresponding Data Table:
 

Table1: Biochemical Parameters and Patient Value Reference Range

In this case, both ALP and LDH levels were within normal limits. Typically, elevated ALP and LDH suggest osteoblastic activity and tumor burden, respectively. Normal levels here may reflect early detection or a low-grade tumor, which has not yet resulted in significant bio-chemical elevation.
 

Table2: Hematological Parameters

Figure2: Biochemicaland Hematological Parameters Vs Normal Midpoints

Discussion

Implant-associated osteosarcoma has been a rare but well-documented occurrence. Chronic inflammatory reactions and corrosion products of metals could be involved in oncogenesis. The majority of previously reported cases had a latency period of several years. For this patient, the five- year latency period between implantation and tumor presentation is consistent with the previous reports.

Pre-implantation diagnosis is difficult owing to similarity with normal postoperative complications. Hence, late or persistent pain/swelling in implant sites should be thoroughly investigated.

Multimodality management, such as orthopedic management, radiotherapy, and chemotherapy, is crucial for optimal results in such patients.

Conclusion

Osteosarcoma, while uncommon, may occur at the location of an orthopedic implant. The clinicians in implanted patients should maintain a high level of suspicion for neoplastic processes with new or increasing symptoms. Multidisciplinary management, including Department of Radiotherapy, Department of Biochemistry enhances the promise of survival along with functional outcomes.

References

1. Unni, K. Krishnan, and Carrie Y. Inwards. Dahlin’s bone tu- mors: general aspects and data on 10,165 cases. Lippincott Williams & Wilkins, 2010.
   View at Publisher | View at Google Scholar
2. Widhe, Björn, and Torulf Widhe. “Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma.” JBJS 82, no. 5 (2000): 667.
   View at Publisher | View at Google Scholar
3. Huvos AG. Bone Tumors: Diagnosis, Treatment, and Progno- sis. 2nd ed. Philadelphia: W.B. Saunders; 1991.
   View at Publisher | View at Google Scholar
4. Sung HH, Dedrick DK, Stover SM. Osteosarcoma associated with internal fixation in a dog. Vet Comp Orthop Traumatol. 2010;23(4):301–304.
   View at Publisher | View at Google Scholar
5. Gillespie, W. J., C. M. Frampton, R. J. Henderson, and P. M. Ryan. “The incidence of cancer following total hip replace- ment.” The Journal of Bone & Joint Surgery British Volume 70, no. 4 (1988): 539-542.
   View at Publisher | View at Google Scholar
6. Hwang K, Kim DJ, Lee SI. Osteosarcoma following open re- duction and internal fixation: A case report. J Korean Med Sci. 1995;10(3):231–234.
   View at Publisher | View at Google Scholar
7. Lewis, Valerae O. “What’s new in musculoskeletal oncology.” JBJS 91, no. 6 (2009): 1546-1556.
   View at Publisher | View at Google Scholar
8. Grimer RJ, Carter SR, Tillman RM, et al. Endoprosthetic re- placement of the proximal femur for bone tumors. J Bone Joint Surg Br. 1999;81(6):1045-1050.
   View at Publisher | View at Google Scholar
9. Mirra JM, Picci P, Gold RH. Bone Tumors: Clinical, Radiolog- ic, and Pathologic Correlations. Philadelphia: Lea & Febiger; 1989.
   View at Publisher | View at Google Scholar
10. Tunn PU, Feigenberg J, Goerling U. Osteosarcoma following internal fixation: a case report and review of the literature. J Cancer Res Clin Oncol. 2005;131(6):420–424.
    View at Publisher | View at Google Scholar