Skip to main content

Osteosarcoma Multidisciplinary Approach to the Management from the Pathologist’s Perspective

  • Chapter
  • First Online:
Pediatric and Adolescent Osteosarcoma

Part of the book series: Cancer Treatment and Research ((CTAR,volume 152))

Abstract

Osteosarcoma is a primary malignant tumor of the bone in which proliferating neoplastic cells produce osteoid and/or bone, if only in small amounts. This histological principle defines a tumor that usually affects young males more frequently than females, and disproportionately involves the long bones of the appendicular skeleton. These tumors are generally locally aggressive and tend to produce early, lethal systemic metastases. However, osteosarcoma is not a single disease but a family of neoplasms, sharing the single histological finding of osseous matrix production in association with malignant cells.

The majority (i.e., 75%) of cases are relatively stereotypical from the demographic, clinical, radiographic and histologic points of view. These tumors generally occur in the metaphyseal portion of the medullary cavity of the long bone and are referred to as “Conventional Osteosarcoma.” The group is sub classified by the form of the dominant matrix present within the tumor, which may be bone, cartilage or fibrous tissue, and it is correspondingly referred to as osteoblastic, chondroblastic and fibroblastic osteosarcoma.

The remaining 25% of cases have unique parameters that allow reproducible identification of tumors which are biologically different from conventional osteosarcoma and are referred to as “Variants.” The parameters identifying Variants fall into one of three major groups: (1) clinical factors, (2) histologic findings and (3) location of origin − within or on the cortex. Because of their inherent biological difference from Conventional Osteosarcoma, the Variants identify cases which must be excluded from analysis of data pertaining to the treatment of the majority of cases: Conventional Osteosarcoma.

The diagnostic parameters of osteosarcoma must be sufficiently inclusive to identify all the members of this potentially lethal tumor. Conversely, criteria for sub classification must be restricted to assure homogenous populations of tumors productively incorporating different biological behavior and the potential for development of unique treatment strategies which are different from those for Conventional Osteosarcoma. This can be designated “Classification Based Therapy” or “Therapy Based Osteosarcoma.”

With this background, we will discuss the highly disciplined approach to the management of osteosarcoma from the pathologist’s perspective. Factors governing the assessment of the response to preoperative chemotherapy will also be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Dahlin DC, Unni KK. Osteosarcoma and its important recognizable variants. Am J Surg Pathol. 1977;1:61-72.

    Article  CAS  PubMed  Google Scholar 

  2. Lichtenstein L. Bone Tumors. 4th ed. St Louis: CV Mosby Company; 1972:215-243.

    Google Scholar 

  3. Unni KK. Osteosarcoma in bone. In: Unni KK, ed. Bone Tumors. New York: Churchill Livingston; 1988:107-133.

    Google Scholar 

  4. Matsuno T, Unni KK, Mc Cleod RA, et al. Telangiectatic osteosarcoma. Cancer. 1976;38:2538-2547.

    Article  CAS  PubMed  Google Scholar 

  5. Farr GH, Huvos SG, Marcove RC, et al. Telangiectatic osteogenic sarcoma: a review of twenty eight cases. Cancer. 1974;34:1150-1158.

    Article  CAS  PubMed  Google Scholar 

  6. Huvos AG, Rosen G, Bretsky SS, et al. Telangiectatic osteosarcoma; a clinicopathologic study of 124 cases. Cancer. 1982;49:1679-1689.

    Article  CAS  PubMed  Google Scholar 

  7. Eidekin J, Raymond AK, Ayala AC, et al. Small cell oseosarcoma. Skeletal Radiol. 1987;16:621-628.

    Article  Google Scholar 

  8. Sim FH, Unni KK, Beabout JW, et al. Osteosarcoma with small cells simulating Ewing’s tumor. J Bone Joint Surg. 1979;61A:207-215.

    Google Scholar 

  9. Dahlin DC, Unni KK, Matsumo T. Malignant (fibrous) histiocytoma of bone – fact or fancy? Cancer. 1977;39:1508-1516.

    Article  CAS  PubMed  Google Scholar 

  10. Wold LE. Fibrohistiocytic tumors of bone. In: Unni KK, ed. Bone Tumors. New York: Churchill Livingstone; 1988:183-197.

    Google Scholar 

  11. Balance WA, Mendelson G, Carter JA, et al. Osteogenic sarcoma. Malignant fibrous histiocytoma subtype. Cancer. 1988;62:763-771.

    Article  Google Scholar 

  12. Unni KK, Dahlin DC, Mc Cleod RA. Intraosseous well differentiated osteosacoma. Cancer. 1977;40:1337-1347.

    Article  CAS  PubMed  Google Scholar 

  13. Ahuja SC, Villacin AB, Smith J, et al. Juxtacortical (parosteal) osteogenic sarcoma: histological grading and prognosis. J Bone Joint Surg. 1977;59:632-647.

    CAS  PubMed  Google Scholar 

  14. Schajowicz F, Mc Guire MH, Araiyo ES, et al. Osteosarcomas arising on the surfaces of long bones. J Bone Joint Surg. 1988;70A:555-564.

    Google Scholar 

  15. Unni KK. Osteosarcoma of bone. In: Unni KK, ed. Bone Tumors. New York: Churchill Livingstone; 1988:107-133.

    Google Scholar 

  16. Hall RB, Robinson LH, Malawer MM, et al. Periosteal osteosarcoma. Cancer. 1985;55:165-171.

    Article  CAS  PubMed  Google Scholar 

  17. Unni KK, Dahlin DC, Beabout JW. Periosteal osteosarcoma. Cancer. 1976;37:2476-2485.

    Article  CAS  PubMed  Google Scholar 

  18. Wold LE, Unni KK, Beabout JW, et al. High-grade surface osteosarcoma. Am J Surg Pathol. 1984;8:181-186.

    Article  CAS  PubMed  Google Scholar 

  19. Unni KK. Osteosarcoma of bone. In: Unni KK, ed. Bone Tumors. New York: Churchill Livingstone; 1988:107-133.

    Google Scholar 

  20. Clark JL, Unni KK, Dahlin DC, et al. Osteosarcoma of the jaw. Cancer. 1983;51:2311-2316.

    Article  CAS  PubMed  Google Scholar 

  21. Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft tissue tumors. J Bone Joint Surg. 1982;64:1121-1127.

    CAS  PubMed  Google Scholar 

  22. Raymond AK, Ayala AG. Specimen management after chemotherapy. In: Unni KK, ed. Bone Tumors. New York: Churchill Livingstone; 1988:157-181.

    Google Scholar 

  23. Weatherby RP, Unni KK. Practical aspects of handling orthopedic specimens in the surgical pathology laboratory. Pathol Annu. 1982;17:1-31.

    PubMed  Google Scholar 

  24. Raymond AK, Chawla SP, Carrasco HC, et al. Osteosarcoma chemotherapy effect: a prognostic factor. Semin Diagn Pathol. 1987;4:212-236.

    CAS  PubMed  Google Scholar 

  25. Jaffe N, Knapp J, Chuang VP, et al. Osteosarcoma: Intra-arterial treatment of the primary tumor with cis-diamminedichloroplatinum-II (CDP) angiographic, pathologic, and pharmacologic studies. Cancer. 1983;51:402-407.

    Article  CAS  PubMed  Google Scholar 

  26. Carrasco CH, Chawla EP, Benjamin RS, et al. Arteriographic production of tumor necrosis after primary treatment of osteosarcoma in adults (abstract). Proc Am Soc Clin Oncol. 1987;6:126.

    Google Scholar 

  27. Carrasco CH, Charnasangavej C, Richli WR, et al. Angiographic response of assessment to preoperative chemotherapy in osteosarcoma. Radiology. 1989;170:839-843.

    CAS  PubMed  Google Scholar 

  28. Kupman W, Lechner G, Wittich GR. The angiographic response of osteosarcoma following preoperative chemotherapy. Skeletal Radiol. 1985;15:96-102.

    Google Scholar 

  29. Benjamin RS. Chemotherapy for osteosarcoma. In: Unni KK, ed. Bone Tumors. New York: Churchill Livingstone; 1988:149-156.

    Google Scholar 

  30. Nachman J, Simon MA, Dean L, et al. Disparate histologic response in simultaneously resected primary and metastatic osteosarcoma. J Clin Oncol. 1987;5:1185-1190.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Kevin Raymond .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Raymond, A.K., Jaffe, N. (2009). Osteosarcoma Multidisciplinary Approach to the Management from the Pathologist’s Perspective. In: Jaffe, N., Bruland, O., Bielack, S. (eds) Pediatric and Adolescent Osteosarcoma. Cancer Treatment and Research, vol 152. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-0284-9_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0284-9_4

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-0283-2

  • Online ISBN: 978-1-4419-0284-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics