Abstract
Purpose
Osteosarcoma is the most common malignant bone tumor in children and adolescents. Brain metastasis from osteosarcoma was once uncommon; however, with the advent of chemotherapeutic agents and improved imaging modalities, it has become a more common and recognized finding. Brain metastases are, rarely, the initial presenting symptom, but instead are a late and preterminal event in the disease process. When osteosarcomas manifest in the central nervous system, they tend to occur in the gray–white junction in the anterior circulation akin to other metastatic lesions in the brain.
Case report
The authors report a case of a 16-year-old boy who presented with acute neurological deterioration due to a posterior fossa hemorrhage and was subsequently found to have a primary site localizing to the metaphysis of the right femur with florid metastatic disease.
Conclusions
This is the first case reported in the literature in which an osteosarcoma initially presented as cerebral metastasis in the form of a posterior fossa hemorrhage with a rapidly deteriorating course.
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References
Ashkan K, Pollock J, D'Arrigo C, Kitchen ND (1998) Intracranial osteosarcomas: Report of four cases and review of the literature. J Neurooncol 40:87–96
Bar-Sela G, Tzuk-Shina T, Zaaroor M, Vlodarsky Y, Tsalik M, Kuten A (2001) Primary osteogenic sarcoma arising from the dura mater: case report. Am J Clin Oncol 24:418–420
Baram TZ, van Tassel P, Jaffe NA (1988) Brain metastases in osteosarcoma: incidence, clinical, and neuroradiological findings and management options. J Neurooncol 6:47–52
Bindal RK, Sawaya RE, Leavens ME, Taylor SH, Guinee VF (1994) Sarcoma metastatic to the brain: results of surgical treatment. Neurosurgery 35:185–190 discussion 190-181
Caramella C, Roujeau T, Drape JL, Minkin K, Krainik C, Kahan A, Allanore Y (2006) Osteosarcoma presenting as a solitary focus of osteolysis in the calvarium. Jt Bone Spine 73:459–461
Chang JW, Howng SL, Sun ZM, Kuo TH, Duh CC (1994) An unusual intracranial metastasis of osteosarcoma. Gaoxiong Yi Xue Ke Xue Za Zhi 10:700–704
Danziger J, Wallace S, Handel SF, deSantos LA (1979) Metastatic osteogenic sarcoma to the brain. Cancer 43:707–710
Gokgoz N, Wunder JS, Mousses S, Eskandarian S, Bell RS, Andrulis IL (2001) Comparison of p53 mutations in patients with localized osteosarcoma and metastatic osteosarcoma. Cancer 92:2181–2189
Hettmer S, Fleischhack G, Hasan C, Kral T, Meyer B, Bode U (2002) Intracranial manifestation of osteosarcoma. Pediatr Hematol Oncol 19:347–354
Kebudi R, Ayan I, Gorgun O, Agaoglu FY, Vural S, Darendeliler E (2005) Brain metastasis in pediatric extracranial solid tumors: survey and literature review. J Neurooncol 71:43–48
Lewis AJ (1988) Sarcoma metastatic to the brain. Cancer 61:593–601
Marina NM, Pratt CB, Shema SJ, Brooks T, Rao B, Meyer WH (1993) Brain metastases in osteosarcoma. Report of a long-term survivor and review of the St. Jude Children's Research Hospital experience. Cancer 71:3656–3660
Menassa L, Haddad S, Aoun N, Slaba S, Atallah N (1997) Isolated brain metastases of osteosarcoma in a patient presenting with a patent foramen ovale. Eur Radiol 7:365–367
Salvati M, Cervoni L, Caruso R, Gagliardi FM, Delfini R (1998) Sarcoma metastatic to the brain: a series of 15 cases. Surg Neurol 49:441–444
Sarno JB, Wiener L, Waxman M, Kwee J (1985) Sarcoma metastatic to the central nervous system parenchyma: a review of the literature. Med Pediatr Oncol 13:280–292
Sipos EP, Tamargo RJ, Epstein JI, North RB (1997) Primary intracerebral small-cell osteosarcoma in an adolescent girl: report of a case. J Neurooncol 32:169–174
Strauss SJ, McTiernan A, Whelan JS (2004) Late relapse of osteosarcoma: implications for follow-up and screening. Pediatr Blood Cancer 43:692–697
Wexler LH, DeLaney TF, Saris S, Horowitz ME (1993) Long-term survival after central nervous system relapse in a patient with osteosarcoma. Cancer 72:1203–1208
Yonemoto T, S-i T, Ishii T, Osato K, Takenouchi T (2003) Long-term survival after surgical removal of solitary brain metastasis from osteosarcoma. Int J Clin Oncol 8:340–342
Acknowledgments
The authors thank Dr. Steven S. Chin for providing the histology figures and Kristin Kraus, M.Sc., for editorial assistance in preparing the paper.
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Niazi, T.N., Forester, C., Afify, Z. et al. Osteosarcoma presenting as hemorrhagic cerebellar metastasis. Childs Nerv Syst 25, 1643–1647 (2009). https://doi.org/10.1007/s00381-009-0987-3
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DOI: https://doi.org/10.1007/s00381-009-0987-3