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The threat of misdiagnosis of primary osteosarcoma over the age of 60: a series of seven cases and review of the literature

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Osteosarcoma is the most common, non-haematopoietic, primary malignant bone tumour with an incidence of 0.3–0.5 per 100,000. There is some discrepancy in literature concerning the peaks of incidence of osteosarcoma. Some describe only one peak which arises in adolescence, whilst others report a bimodal age distribution with a second peak over the age of 60. In this retrospective study, we evaluated osteosarcoma patients over age 60 treated at our department and reviewed previous studies from the literature.

Patients and methods

Sixty-four patients (40 male, 24 female) with a mean age of 29 years (from 7 to 82) were treated for primary osteosarcomas. At the time of diagnosis, seven patients (two male and five female) were over 60 years of age with a mean follow-up of 46 months after definite diagnosis.

Results

Three out of seven osteosarcomas were primarily radiologically or histologically misdiagnosed, but only one was mistreated with intramedullary nailing at a trauma centre. At last follow-up, two patients had died from the disease, three were alive with disease, and two had no evidence of osteosarcoma.

Conclusions

We did not find an increased incidence of primary osteosarcoma in the elderly; yet, older patients had a higher rate of misdiagnosis due to untypical radiological findings in combination with longer times from the onset of first symptoms to definite diagnosis. In cases of pathological fracture, it is essential to assess whether it is caused by mechanical stress or a primary or secondary tumour before leading into mistreatment, especially in older patients.

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Authors and Affiliations

  1. University Clinic of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5-7, 8036, Graz, Austria

    Patrick Sadoghi, Andreas Leithner, Heimo Clar, Mathias Glehr, Christine Wibmer & Reinhard Windhager

  2. Department of Orthopaedics, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany

    Patrick Sadoghi

  3. Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria

    Koppany Bodo

  4. Institute of Medical Statistics, Informatics and Documentation, Medical University of Graz, Auenbruggerplatz 12, 8036, Graz, Austria

    Franz Quehenberger

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  1. Patrick Sadoghi
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  2. Andreas Leithner
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  3. Heimo Clar
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  4. Mathias Glehr
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  8. Reinhard Windhager
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Correspondence to Andreas Leithner.

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Sadoghi, P., Leithner, A., Clar, H. et al. The threat of misdiagnosis of primary osteosarcoma over the age of 60: a series of seven cases and review of the literature. Arch Orthop Trauma Surg 130, 1251–1256 (2010). https://doi.org/10.1007/s00402-009-1011-9

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  • DOI: https://doi.org/10.1007/s00402-009-1011-9

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