Case Report
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World J Orthop. Oct 18, 2013; 4(4): 327-332
Published online Oct 18, 2013. doi: 10.5312/wjo.v4.i4.327
Low-grade central osteosarcoma of distal femur, resembling fibrous dysplasia
Haris S Vasiliadis, Christina Arnaoutoglou, Sotiris Plakoutsis, Michalis Doukas, Anna Batistatou, Theodoros A Xenakis
Haris S Vasiliadis, Christina Arnaoutoglou, Sotiris Plakoutsis, Theodoros A Xenakis, Department of Orthopaedics, University Hospital of Ioannina, 45500 Ioannina, Greece
Michalis Doukas, Anna Batistatou, Department of Pathology, University Hospital of Ioannina, 45500 Ioannina, Greece
Author contributions: Vasiliadis HS, Doukas M, Batistatou A and Xenakis TA designed research; Vasiliadis HS, Plakoutsis S and Doukas M performed research; Plakoutsis S, Doukas M and Batistatou A contributed new reagents or analytic tools; Vasiliadis HS, Arnaoutoglou C, Doukas M, Batistatou A and Xenakis TA analyzed data; Vasiliadis HS, Arnaoutoglou C and Plakoutsis S wrote the paper; Vasiliadis HS, Arnaoutoglou C and Xenakis TA performed surgical operation; Doukas M and Batistatou A performed histological evaluation.
Correspondence to: Haris S Vasiliadis MD, PhD, Department of Orthopaedics, University Hospital of Ioannina, Panepistimiou 4, 45500 Ioannina, Greece. vasiliadismd@gmail.com
Telephone: +30-26-51099682 Fax: +30-26-51093245
Received: February 20, 2013
Revised: June 7, 2013
Accepted: June 19, 2013
Published online: October 18, 2013
Processing time: 249 Days and 19.7 Hours
Abstract

We report a case of a 32 year-old male, admitted for a lytic lesion of the distal femur. One month after the first X-ray, clinical and imaging deterioration was evident. Open biopsy revealed fibrous dysplasia. Three months later, the lytic lesion had spread to the whole distal third of the femur reaching the articular cartilage. The malignant clinical and imaging features necessitated excision of the lesion and reconstruction with a custom-made total knee arthroplasty. Intra-operatively, no obvious soft tissue infiltration was evident. Nevertheless, an excision of the distal 15.5 cm of the femur including 3.0 cm of the surrounding muscles was finally performed. The histological examination of the excised specimen revealed central low-grade osteosarcoma. Based on the morphological features of the excised tumor, allied to the clinical findings, the diagnosis of low-grade central osteosarcoma was finally made although characters of a fibrous dysplasia were apparent. Central low-grade osteosarcoma is a rare, well-differentiated sub-type of osteosarcoma, with clinical, imaging, and histological features similar to benign tumours. Thus, initial misdiagnosis is usual with the condition commonly mistaken for fibrous dysplasia. Central low-grade osteosarcoma is usually treated with surgery alone, with rare cases of distal metastases. However, regional recurrence is quite frequent after close margin excision.

Keywords: Osteosarcoma; Fibrous dysplasia of bone; Distal femur; Custom-made total knee arthroplasty; Tumour

Core tip: We report a case of a 32 year-old male, admitted for a lytic lesion of the distal femur. Although open biopsy suggested fibrous dysplasia, clinical and radiological evaluation indicated malignancy. Histological examination of the excised specimen revealed central low-grade osteosarcoma. Central low-grade osteosarcoma is a rare, well-differentiated, sub-type of osteosarcoma, with clinical, imaging, and histological features in keeping with benign tumours. Thus, initial misdiagnosis is common, typically being mistaken for fibrous dysplasia. Central low-grade osteosarcoma is usually treated with surgery in isolation, with rare cases of distal metastases. However, regional recurrence is quite frequent after close margin excision.