A CASE OF TELANGIECTATIC OSTEOSARCOMA OF HUMERUS - A CASE REPORT

Abstract

INTRODUCTION Telengiectatic osteosarcoma is an uncommon variant of osteosarcoma constituting 0.4- 12 of osteosarcomas. They were presumed to originate from               transformed osteoblasts or stem cells of mesenchymal origin. Male female ratio of 21.Most common age group is 10- 30 years.CASE REPORT 34 year old male came with pain and swelling over the right arm for six months with insiduous onset increasing in size for the past 1 month. On inspection diffuse swelling noted over whole right arm, skin over swelling stretched and shiny, 201 cm surgical scar seen over the  anterolateral aspect of right arm and enlarged veins seen .On palpation, Warmth, tender, Variable in consistency. Range of motion of shoulder and elbow painfully restricted with no distal neurovascular deficit. During time of presentation patient had undergone two previous surgeries done outside. Patient  presented to our hospital after second surgery, 2 months later with increase in pain and swelling. Pre operative evaluation done with X ray Rt arm AP Lateral, CT chest CECT abdomen done to identify primary and to rule out metastasis which were negative. FNAC was positive for malignant cells. Bone scan showed no skip metastasis other than humerus. During the course patient develped bleeding from the tumor site             spontaneously. Tumor has been staged Enneking Stage IIB. Since limb salvage is not possible at this stage Shoulder  disarticulation was done. CONCLUSION With Neo- adjuvant Chemotherapy and Surgery ,survival rates for TO better than conventional OS. If treated only with surgery, prognosis worse than conventional OS. Early diagnosis and prompt treatment important for disease free survival. So staged work up is             always essential in an osteolytic lesion. Always take a Biopsy before going for any definitive procedure.