Di căn phổi từ sarcoma xương thể giãn mạch hay u tế bào khổng lồ? Báo cáo trường hợp bệnh và thách thức trong thực hành lâm sàng

Abstract

Bone sarcoma is derived from bone - forming stem cells. Histopathology of osteosarcoma according to the classification of the World Health Organization in 2002 includes: (1) Common osteosarcoma (accounting for 70-75% of cases); (2) Small cell osteosarcoma; (3) Highly malignant superficial osteosarcoma; (4) Telangiectatic osteosarcoma; (5) Secondary osteosarcoma (in Paget, after radiation); (6) Low-grade central osteosarcoma; (7) Paracortical bone sarcoma; (8) Periosteal osteosarcoma. Bone sarcoma often has high malignancy, early metastasis, even detected metastases at the time of diagnosis, the most common site of metastasis is the lung.       Telangiectatic osteosarcoma (TOS) is a rare subtype of bone sarcoma. The disease usually occurs at the tip of the long tubular bones. The femur is the most common site, followed by the humerus and tibia. Histologically, TOS is described as consisting of many small dilated aneurysms filled with blood and high-grade sarcomatous cells can be observed in the peripheral rim and in the septum.        We present a case that was initially clinically diagnosed with giant cell tumor and underwent amputation more than 1 year before the reporting time. Pathology at that time warned that this could be telangiectatic osteosarcoma (TOS), but the patient did not pay attention to adjuvant treatment. One year later, the patient presented with lung metastases with tumor filling the lumen of the left main bronchus causing complete collapse of the lung on one side and several other nodules on the opposite lung. It is strongly recommended that the correct determination of benign/malignant status or the differential diagnosis between osteoblastic giant cell tumor and vasodilating osteosarcoma at the time of surgery is extremely important.