| Background:The primary bone tumor is2percent of all tumor, and the Low Grade Central Osteosarcoma is less than1percent of the primary bone tumor. It is found by imaging study because the local pain, swelling. Unni first reported27cases the tumor in1977, and established the subtype in his theory. Literature reported about100cases during the last30years, and most of them from Mayo Clinic. However, more cases was report as the better detection rate. Domestic literature all report30cases since2007to2013. This tumor is known lately, the course of disease is longer before it’s diagnosis, generally no specific clinical symptoms, the imaging findings is mixed, mostly only find bone destruction. In the earlier of the tumor, it’s even without any signs of malignancy. So diagnose the LGCOS only by the imaging study is impossible. Like the osteofibrous dysplasia, the histological is mild. So it’s easily to misdiagnose as benign lesions. Therefore, we should be combined as clinical and imaging data when we diagnose the diease.Objective:Our study on this condition is to analysis the diagnosis, treatment and prognosis of the Low Grade Central Osteosarcoma. Method:A retrospective analysis was performed with the9cases of the Fudan University, the5cases of the Third Military Medical University and the2cases of the Bone Tumor Centre of the Qilu Hospital, Shandong University. Including the clinical manifestation, imaging finding, treatment and prognosis.Result:Among the16cases of the LGCOS,4cases are male,12cases are female, the sexual rate is1:3. The onset age is from15to65, the average age of onset is34.8+13.2years. Invasion site:limb bone is13cases (81.25%), spine is2cases (12.50%) and other is1case (6.25%). There are5cases in the11cases which were follow-up visit.4cases of them. The course of LGCOS is longer before it’s diagnosis, the indidence rate is low, generally no specific clinical symptoms, the imaging finding may be expressed as benign lesions, the diagnosis is rely on pathological diagnosis and the clinical diagnosis is difficult. Preoperative biopsy is used to diagnosis, we should completely removed the tumor if the diagnosis is suspected (LGCOS with recurrence is due to not closely removed). The radial case, one of the two patients in our center is first-episode, the operation is "right distal radius tumor resection and wrist joint reconstruction with transplant auto fibular", the postoperative recovery was good, and closely follow-up is doing. The tibia case was recurrence, the diagnosis is undifferentiated pleomorphic sarcoma after the recurrence of the LGCOS. The Statistical Results:in the48cases of foreign data, the average age of onset is27.42±10.22years; and in the18case of literature data, the average age37.78±13.52years; female ratio is not obvious, but it showed the incidence of women older than men. LGCOS appear in the long bones, especially appear in the lower extremity weight-bearing long bones, the knee around the distal femur and proximal tibia (about50%～70%LGCOS total), other bones have appeared.Conclusion:LGCOS have a longer course, the diagnosis is difficult, requires a combination of clinical, radiological and pathological. MDM2and CDK4in distinguishing low-grade osteosarcoma with other benign bone lesions are more reliable, and combined with clinical, imaging and other data, we can identify the another type of low-grade osteosarcoma:parosteal osteosarcoma. The currently treatment is mainly surgical treatment, which is at least radical wide excision and limb salvage, generally considered to put no additional adjuvant therapy and chemotherapy after surgery. LGCOS is very easy to local recurrence after the operation of no complete resection, and maybe differentiated into highly malignant sarcoma or the evolution of distant metastasis. Therefore, complete surgical resection and postoperative long-term follow-up is important. |
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