Chapter 804 Small Cell Osteosarcoma

After returning to the office, Xu Qiu added all the tests to the patient, and also added an angiography.

If the bone scan really found a tumor, then angiography can be further performed, which can better show the extra-bone part of the tumor and the degree of vascular displacement.

Although it is not very meaningful for diagnosis and differentiation, angiography can provide the contour of the tumor and the compression of the surrounding blood vessels, which is an important basis for evaluating whether surgery can be performed, the surgical method and the intraoperative bleeding.

Two days later, the results came out.

First, PET-CT: It showed that the axillary pleural nodules had metastasized.

The results of the genetic test were very encouraging: EGFR19 was missing!

At the same time as the diagnosis, Xu Qiu immediately prescribed the targeted drug osimertinib.

If the effect is good and the lesion can be reduced to 50% of the current level, there is still a chance for surgery.

Now it depends on the bone scan...

Xu Qiu called up the diagnosis interface and his face darkened.

The worst result appeared - the radionuclide scan found abnormal concentrations in the upper part of the left tibia of the lower limb.

The subsequent angiography and pathological biopsy gave a clearer diagnosis:

"In the left upper tibia, a large number of well-differentiated thick beam-shaped or thick reticular tumor bone structures can be seen infiltrating the medullary cavity and normal trabeculae; the tumor tissue infiltrates and destroys the bone cortex; the medullary cavity cutting edge, the fibula cutting edge and the joint capsule sent for examination did not show tumor tissue infiltration, but the tibia cutting edge showed tumor tissue infiltration; the fibula head showed tumor tissue infiltration...

Diagnosis:

1. Low-grade central osteosarcoma in the upper left tibia.

2. No tumor tissue infiltration was found in the medullary cavity cutting edge, the fibula cutting edge and the joint capsule, but the tibia cutting edge showed tumor tissue infiltration."

After seeing this report, Xu Qiu understood why the CT scan did not indicate...

Jiang Dong'er's osteosarcoma was too tricky, deep in the location, and there was no extensive infiltration. In this case, it is very difficult to detect osteosarcoma by CT alone.

If the patient did not have lung adenocarcinoma, Xu Qiu would need several days to proceed to the bone scan.

…

“It’s actually osteosarcoma.” Although Xu Qiu had expected it, he was still surprised when the diagnosis was confirmed.

The incidence of osteosarcoma is only 0.2%, which means there are only two to three cases in every million people.

Despite this, it is also the most common malignant bone tumor, and its incidence among primary bone tumors ranks second only to plasma cell myeloma.

For osteosarcoma, traditional treatments are very ineffective. Whether it is amputation or chemotherapy, the five-year survival rate is less than 20%, and only a small number of people have the opportunity to live more than five years.

However, chemotherapy and surgery are now being innovated and new clinical guidelines are being adopted, which may increase the five-year survival rate to more than 50%.

“This is still a rare small cell osteosarcoma.” Xu Qiu sighed slightly.

Osteosarcoma also has many subtypes, such as typical osteosarcoma, which accounts for about 80% of all osteosarcomas. The clinical manifestations are very typical, that is, pain, swelling, limited movement, increased skin temperature, etc. The tumors often occur in the distal femur and proximal tibia, and can penetrate the epiphysis and invade the joints.

Secondly, the tumor is a large cyst filled with blood, with a septum inside and little bone-like matrix, which is a vascular dilated osteosarcoma; the tumor under the microscope is composed of a spindle-shaped fibroblastic matrix, with slightly atypical nuclei and bone-like matrix, which is a low-grade malignant central osteosarcoma.

In addition, there are pericortical osteosarcoma, periosteal osteosarcoma, highly malignant bone surface osteosarcoma, and small cell osteosarcoma, etc.

Among them, the best prognosis is low-grade malignant central osteosarcoma, which grows very slowly and has a low incidence of metastasis, which is much better than the traditional osteosarcoma.

Highly malignant osteosarcoma is similar to traditional osteosarcoma, with similar treatment methods and prognosis.

The most dangerous is small cell osteosarcoma.

Its incidence is only about 1% in osteosarcoma, mainly composed of small round cells, and its morphology is similar to Ewing sarcoma or other malignant round cell tumors.

According to literature records, even after adopting new treatment methods, the five-year survival rate of patients with small cell osteosarcoma is only 28%.

Far lower than more than 50% of other subtypes.

"Moreover, the location is too deep." Xu Qiu frowned.

Osteosarcoma in the tibial bone marrow has a complex location and many uncertain factors in anatomical positioning. This alone can deter many orthopedic surgeons. Few dare to perform surgery, and basically they can only rely on chemotherapy drugs.

He immediately convened a multidisciplinary consultation.

After the consultation, the plan was also confirmed:

1. High-dose chemotherapy.

2. Combined surgery for radical cure.

High-dose chemotherapy is an effective method for systemic treatment of osteosarcoma. Chemotherapy can kill micro-metastases in the lungs and the whole body. Today's neoadjuvant chemotherapy can cause tumor cell necrosis and tumor shrinkage, promote the disappearance of edema and new tumor blood vessels in the reaction area, and obtain surgical opportunities.

Of course, micro-lesions are more sensitive to chemotherapy. For example, Jiang Dong'er's lung adenoma in the upper lobe of the right lung, although it is a metastasis of osteosarcoma, can only be reduced by osimertinib, and surgery is required to remove the lesion in the later stage.

As for the primary lesion of osteosarcoma in the left tibia, it is still necessary to consider whether to use amputation or limb-sparing surgery.

This should be determined not only based on the results of chemotherapy and various patient information, but also the wishes of the family and the patient himself...

After the consultation, Xu Qiu talked with Jiang Donger's family and informed them of the results of the discussion.

Compared to when they first learned about osteosarcoma, the family of three had calmed down a lot.

Jiang Donger brushed her hair and whispered, "What a pity. I usually take good care of my hair. I will have to shave my head in the future..."

Compared to watching her hair fall out in clumps, shaving her head directly is a more acceptable approach.

Jiang Donger was silent for a while and asked, "Doctor Xu, do you think there is a chance to save my left leg?"

Xu Qiu did not dare to guarantee it and said, "If you do limb-saving surgery, you need to additionally evaluate the biological behavior of the tumor and whether chemotherapy can be controlled, and whether the tumor itself can be extensively locally removed."

Limb-saving surgery is the least recommended surgical method.

In addition to Jiang Donger's complex position, there are also various reconstructions and soft tissue repairs that need to be done. This is a huge surgical project that most hospitals dare not take, so they are directly excluded and will not give patients the opportunity to choose.

Only Xu Qiu dared to give a limb-saving surgery plan.

He reminded: "However, limb-sparing surgery is also the most expensive and risky method. Directly removing the limb is safer and the lesions can be completely removed."

"But in this case, I won't even have legs..." Jiang Dong'er lowered her head.

Neither Jiang's mother nor Jiang's father spoke. Their daughter had her own choice, and all they had to do was to be a solid backing.

After a long time, Jiang Dong'er asked: "If I do amputation, my chance of living for five years is about 30%?"

"The data is like this."

"If you do limb-sparing surgery, the probability of recurrence is higher, and the chance of living for five years drops to 20%..." Jiang Dong'er muttered.

She slowly raised her head and suddenly asked: "Doctor Xu, I want to know, if you do the surgery, what is the chance of me living for more than five years?"

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