LGCmain
Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 820
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
LETTER TO EDITOR  
Year : 2012  |  Volume : 55  |  Issue : 4  |  Page : 595-597
Calcaneal osteosarcoma


Department of Pathology, ASCOMS and Hospital, Sidhra, Jammu and Kasmir, India

Click here for correspondence address and email

Date of Web Publication4-Mar-2013
 

How to cite this article:
Sharma M, Sharma V, Sharma A, Khajuria A. Calcaneal osteosarcoma. Indian J Pathol Microbiol 2012;55:595-7

How to cite this URL:
Sharma M, Sharma V, Sharma A, Khajuria A. Calcaneal osteosarcoma. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Dec 3];55:595-7. Available from: https://www.ijpmonline.org/text.asp?2012/55/4/595/107845


Sir,

Osteosarcoma is the most common primary malignancy of the bone excluding multiple myeloma and frequently involves the knee. [1],[2],[3] It is commonly seen in the second and third decades of life. [2],[3],[4] Osteosarcoma of the foot is very rare. [1],[2] The reported incidence is 0.8% of all osteosarcomas and calcaneum is the most favored site in the foot. [1],[4] It affects the older age group. Owing to the rarity of the location, it is often misdiagnosed or there is a delay in the diagnosis. The literature shows that the time delay for the diagnosis of osteosarcoma of calcaneum ranges between 15 weeks and 28 months. [1],[4] Many factors such as histological grading, patient's age, and the time to definitive diagnosis of the tumor may play a role in the clinical outcome and should be carefully considered. [2]

A 38-year-old male presented with 8-month-old history of pain and swelling on the left ankle in April, 2010. Fine needle aspiration cytology (FNAC) of the patient was done twice before coming to our institute. First FNAC was reported as tubercular granuloma with cold abscess and the patient was put on antitubercular treatment (ATT). The patient did not improve and underwent the second FNAC which revealed blood, scattered giant cells, and a few suspicious large cells with abundant blue cytoplasm and round to oval nuclei. On this report, curettage was done which showed fragments of dead bone, abundant osteoid, and slight anaplasia and he was diagnosed as a case of chronic osteomyelitis. The patient did not respond to treatment. The X-ray foot showed ill-defined heterogeneous sclerotic lesion involving calcaneum with associated pathological fracture and large soft tissue component. [Figure 1]. Correlating the clinico-radiological details, below-knee amputation was done. On gross examination, a diffuse, bulky lesion involving the left ankle was seen. The cut section of the lesion showed gritty, grey white tumor with areas of hemorrhagic and cystic degeneration, involving the calcaneum. The tumor was infiltrating the cortex. Microscopic examination showed abundant eosinophilic osteoid forming lacelike network and thin trabeculae. [Figure 2] In between the osteoid there were pleomorphic, bizarre tumor cells having large, hyperchromatic nuclei. [Figure 3] The mitotic rate was high. Dilated vessels and multinucleated giant cells were also seen. Based on these findings, the patient was diagnosed as having osteosarcoma calcaneum.
Figure 1: Lateral X-ray left foot shows ill-defined heterogeneous sclerotic lesion involving calcaneum with associated pathological fracture and large soft tissue component

Click here to view
Figure 2: Low power examination shows a lacelike pattern of osteoid production (hematoxylin and eosin, ×100)

Click here to view
Figure 3: High power examination shows abundant osteoid intimately associated with anaplastic tumor cells (hematoxylin and eosin, ×400)

Click here to view


Osteogenic sarcoma is the most common non-hematopoietic primary malignant neoplasm of the bone. [2],[4] Although it is the second most common malignant bone tumor, affecting especially children and adolescents, osteosarcoma of the foot is infrequent. [2] It may represent a distinct subgroup that differentiate it from conventional osteosarcoma as it is a low-grade tumor and affects the older age group in contrast to its counterparts at other sites. Osteosarcoma of the foot has been associated with Werner's syndrome, hereditary retinoblastoma, Paget's disease and  Li-Fraumeni syndrome More Details. [2],[4],[5]

These tumors produce symptoms early because of the confined structure of the foot, but their rarity may lead to delay in diagnosis. The patients are frequently misdiagnosed with more common musculoskeletal problems that initially improve with conservative measures. [4]

Histologically, osteosarcoma has been classified as osteoblastic, chondroblastic, and fibroblastic, according to the most predominant matrix. Most of the cases show a mixed pattern. There is no clear correlation between these variants of osteosarcoma and prognosis. But a certain degree of correlation has been reported between some histological variants and their response to radiotherapy. [3] In a series conducted at the Mayo clinic on osteosarcoma foot, the incidence of chondroblastic tumors was high as compared to osteoblastic and most of the tumors were of high grade. [1],[5]

Radiographically, osteosarcomas are commonly sclerotic in 45% of cases, purely lytic in 30%, and mixed in the remaining 25%. [2],[4],[5] Plain radiographs are diagnostic of osteosarcomas. Further radiographic evaluation for ascertaining disease may be necessary with modalities like computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, and radionuclide bone scan. In addition, MRI helps in the accurate estimation of tumor boundaries in relation to the surrounding structures and also detects skip lesions. [2],[5]

Due to the superficial location of the calcaneus and because calcaneus supports the whole body weight, traumatic lesions are common as compared to neoplastic lesions. The differential diagnosis includes all slightly mineralized and ill-defined lesions extending into soft tissues. Osteoid osteoma, desmoplastic fibroma, chondrosarcoma, enchondroma, eosinophilic granuloma, Ewing's sarcoma, and metastatic carcinoma are the most frequent entities in the calcaneum. [3] However, osteosarcoma should also be considered in the differential diagnosis, particularly in the event of a sclerotic bony lesion. [3],[4] And for the confirmation of diagnosis, open biopsy is required to avoid any delay in the management of the patient.

 
   References Top

1.Choong PF, Quereshi AA, Sim FH, Unni KK. Osteosarcoma of the foot: A review of 52 patients at the Mayo Clinic. Acta Orthop Scand 1999; 70:361-4.  Back to cited text no. 1
    
2.Mardanpour K, Rahbar M. Calcaneal osteosarcoma; a case report. Iran J Med Sci 2008; 33:121-3.  Back to cited text no. 2
    
3.Lopez-Barea F, Contreras F, Sanchez-Herrera S. Case report 540. Grade III conventional sclerosing osteosarcoma of the calcaneus. Skeletal Radiol 1989; 18:237-40.  Back to cited text no. 3
    
4.Saini R, Rajan SV, Dhillon MS, Deivaraju C, Mittal N, Gulati A. Osteosarcoma of calcaneum. Bull PGI 2008; 42:124-7.  Back to cited text no. 4
    
5.Agarwal S, Kumar P, Sharma HP. Osteosarcoma of the calcaneum (Letter). Indian J Radiol Imaging 2002; 12:578-9.  Back to cited text no. 5
    

Top
Correspondence Address:
Vandana Sharma
Senior Resident, Department of Pathology, ASCOMS, Sidhra, Janipur, Jammu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.107845

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 CALCANEUM OSTEOSARCOMA A RARE CAUSE OF HEEL PAIN: HOW TO PREVENT DELAY IN THE DIAGNOSIS AND THE REVIEW OF LITERATURE
Abhijeet Ashok Salunke,Tapan Singh Chauhan,Jaymin Shah,Rahul Parmar,Manish Chaudhari,Srikant Konchada,Prateik Joshi,Animesh Singh,Himanshu Kanani,Subodh Pathak,Prahalad U
Journal of Musculoskeletal Research. 2018; 21(01): 1872001
[Pubmed] | [DOI]
2 A case of calcaneal osteomyelitis from the prehispanic population of El Hierro (Canary Islands)
Emilio González-Reimers,Aioze Trujillo-Mederos,Alejandra C. Ordóñez,Matilde Arnay-da-la-Rosa
International Journal of Paleopathology. 2015; 8: 36
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed3269    
    Printed52    
    Emailed0    
    PDF Downloaded68    
    Comments [Add]    
    Cited by others 2    

Recommend this journal