jkss Journal of Korean Society of Spine Surgery Journal of Korean Spine Surg 2093-4378 2093-4386 Korean Society of Spine Surgery 10.4184/jkss.2013.20.3.118 jkss-20-118 Case Report Primary Osteosarcoma of the Thoracic Vertebra - A Case Report - Ha Kee-Yong M.D. Kim Young-Hoon M.D. Yoo Tae-Wook M.D. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Corresponding author: Young-Hoon Kim, M.D. Department of Orthopedic Surgery, Seoul St. Mary's Hosptial 505 Banpo-dong, Seocho-gu, Incheon, Korea TEL: 82-32-2258-2837, FAX: 82-32-2258-2837 E-mail: boscoa@catholic.ac.kr 92013 2192013 203 118122 11082011 30092011 05102012 Copyright © 2013 Korean Society of Spine Surgery 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Study Design

Case report.

 Objectives

To report a case of osteosarcoma involving the thoracic spine in an elderly patient.

 Summary of Literature Review

Spinal osteosarcoma has been reported as a relatively low incidence (3-5%) of musculoskeletal osteosarcoma. Dominant histologic type was osteoblastic. Radical excision or palliative excision followed by adjuvant chemotherapy and radiation therapy was tried. The overall prognosis was shown to be poorer than osteosarcomas in other skeletal areas.

 Materials and Methods

A review of clinical and radiologic data of osteosarcoma involving the 12th thoracic spine that were confirmed by histopathology.

 Results

Palliative surgery followed by adjuvant radiation therapy and chemotherapy was performed.

 Conclusions

We report here the clinical and radiological findings of a case of osteosarcoma that arose in the thoracic spine with a literature review.

 Vertebra Osteosarcoma REFERENCES Tokuhashi Y Matsuzaki H Oda H Oshima M Ryu J A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis Spine (Phila Pa 1976) 2005 30 218691 Ozaki T Flege S Liljenqvist U Osteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group Cancer 2002 94 106977 Schoenfeld AJ Hornicek FJ Pedlow FX Osteosarcoma of the spine: experience in 26 patients treated at the Massachusetts General Hospital Spine J 2010 10 70814 Ilaslan H Sundaram M Unni KK Shives TC Primary vertebral osteosarcoma: imaging findings Radiology 2004 230 697702 Kawahara N Tomita K Fujita T Maruo S Otsuka S Kinoshita G Osteosarcoma of the thoracolumbar spine: total en bloc spondylectomy. A case report J Bone Joint Surg Am 1997 79 4538 Tomita K Kawahara N Kobayashi T Yoshida A Mu-rakami H Akamaru T Surgical Strategy for Spinal Metastases Spine (Phila Pa 1976) 2001 26 298306 Chung JY Spinal tumors J Korean Soc Spine Surg 1999 6 31625 DeLaney TF Park L Goldberg SI Radiotherapy for local control of osteosarcoma Int J Radiat Oncol Biol Phys 2005 61 4928 Yalniz E Ozcan M Copuroglu C Memisoglu S Yalcın O Osteosarcoma of the lumbar vertebra: case report and a review of the literature: rare localization with long survival Arch Orthop Trauma Surg 2009 129 17015 Mankin HJ Hornicek FJ Rosenberg AE Survival data for 648 patients with osteosarcoma treated at one in-stitution Clin Orthop Relat Res 2004 429 28691 Bielack SS Kempf-Bielack B Delling GG Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols J Clin Oncol 2002 20 77690 Figures

(A) TL spine AP & lateral radiographs shows the loss of right side pedicle and collapse of T12 (arrow). (B) Bone scintigraphy shows the abnormal hot uptake at T12 that is corresponding to other radiologic findings.

(A) MRI shows heterogenous signal mass of the T12 and posterior portion of T11 body and extraspinal mass extending to spinal canal and neural foramen. (B) PET-CT shows no abnormal FDG-uptake except for the T11 & T12 spine.

(A) Palliative surgery with posterior decompression and stabilization was performed. (B) Postoperative 3 months radiographs show collapse of T12 vertebral body without significant loss of stabilization.

Microscopic finding shows tumor cells with oval or spindle-shaped nucleus and mitosis. Multiple giant cells like osteoclasts (arrow) are also seen. Osteoid formation (arrow head) and necrotic tissue formation are evident (HE stain, ×200).