Osteosarcoma
Key Facts
Terminology
Malignant mesenchymal neoplasm with osseous differentiation
Clinical Issues
Incidence
Osteosarcomas of lung are exceedingly rare with > 30 cases reported
Pulmonary osteosarcomas appear to be more common in 5th and 6th decades of life
Symptoms
Cough
Dyspnea
Chest pain
Hemoptysis
Asymptomatic
Laboratory findings
In most cases of pulmonary osteosarcoma, levels of alkaline phosphatase are normal
Treatment and prognosis
No specific treatment
Poor survival
Death may occur within 12 months after initial diagnosis
Top Differential Diagnoses
Bronchial chondroma
May show ossification in center of lesion
Chondrosarcomas
Does not show osteoid formation
Does not display cellular atypia &/or mitotic activity
Carcinosarcoma
Displays epithelial component
 Primary pulmonary osteosarcoma shows a pleomorphic cellular proliferation with numerous multinucleated giant cells of the osteoclast type. Note the presence of uninvolved lung parenchyma  . |
 High-power view of an osteosarcoma shows osteoid deposition  and a rim of neoplastic cells  . |
TERMINOLOGY
Synonyms
Osteogenic sarcoma
Definitions
Malignant mesenchymal neoplasm with osseous differentiation
CLINICAL ISSUES
Epidemiology
Incidence
Osteosarcomas of lung are exceedingly rare with < 30 cases reported in the literature
Age
Osteosarcomas of lung appear to be more common in 5th and 6th decades of life
Gender
No gender predilection
Presentation
Cough
Shortness of breath
Chest pain
Hemoptysis
Asymptomatic
Laboratory Tests
In most cases of pulmonary osteosarcoma, levels of alkaline phosphatase are normal
Treatment
Surgical approaches
Lobectomy or pneumonectomy
Adjuvant therapy
Chemo-radiation is questionable
There is no specific treatment
Prognosis
Poor survival
Death may occur within 12 months after initial diagnosis
MACROSCOPIC FEATURES
General Features
Well-defined tumor
Solid, “rock-hard”
Size
Varies from 4 to > 10 cm in diameter
MICROSCOPIC PATHOLOGY
Histologic Features
Malignant spindle cell proliferation
Osteoid formation
Osteoclast giant cells
Mitotic activity
Cartilaginous component may be present
Predominant Pattern/Injury Type
Ossification
Predominant Cell/Compartment Type
Spindle
DIFFERENTIAL DIAGNOSIS
Bronchial Chondroma
May show ossification in center of lesion
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