Osteosarcoma of the Femur Presenting with Intravenous Tumoral Thrombus
A 35-year-old man with history of a mass in the left lower thigh presented with recent onset of pain. Radiograph revealed a densely ossified soft-tissue mass epicentered around the lower femur (Figure, A). CT angiography showed a large soft-tissue mass with exuberant osteoid-type matrix mineralization centered at the distal metaphysis (Figure, B) which appeared hypointense at T2-weighted MRI (Figure, C and D). Osteosarcoma was the primary consideration in the differential diagnosis. In addition, imaging identified an elongated, tubular, calcified lesion that was in continuity with the mass at distal metaphysis and extended into the dilated popliteal vein, creating a filling defect, which is characteristic of a tumor thrombus (Figure, B–D). Biopsy revealed chondroblastic osteosarcoma with 50% necrosis.
Chondroblastic osteosarcoma is a rare, deleterious subtype of osteosarcoma that accounts for approximately 25% of all cases. These tumors have a high propensity for intravascular spread, leading to life-threatening tumor thrombi (1,2). Malignancies typically induce a hypercoagulable state, which further increases incidence of thrombosis. Distinguishing tumor from bland thrombus is essential to ensure appropriate therapeutic decisions, as patients with tumor thrombus may have a contraindication to anticoagulants (2). Management includes a multidisciplinary approach coordinated by the oncology team (3).
Disclosures of conflicts of interest: R.Y. No relevant relationships. S.G. No relevant relationships.Keywords: CT, Biopsy, Needle Aspiration, Skeletal-Appendicular
Authors declared no funding for this work.
References
- 1. . Pulmonary artery and femoral vein tumour thromboembolism in a patient with osteogenic sarcoma demonstrated by FDG PET/CT. Eur J Nucl Med Mol Imaging 2010;37(3):653.
- 2. . Pelvic venous thromboembolism leading to pulmonary embolism in a case of chondroblastic osteosarcoma detected on FDG PET/CT. Indian J Nucl Med 2021;36(2):231–232.
- 3. . Chondroblastic osteosarcoma. J Oral Maxillofac Pathol 2014;18(3):464–468.
Article History
Received: Apr 11 2023Revision requested: Apr 11 2023
Revision received: May 23 2023
Accepted: May 31 2023
Published online: July 21 2023