osteosarcoma?

RE: osteosarcoma?

mariette asselbergs — Wed, 30 Nov 2016 13:37:06 GMT

Thanks for posting this interesting case. Please post the outcome in due time!

Mariette

RE: osteosarcoma?

dave reid — Tue, 29 Nov 2016 21:45:59 GMT

Should have come back earlier and read your thread Malcolm. Taken a while to sort this case as the owner working shifts and I've been awaiting 2nd opinions on lab results. I got a core bone biopsy with a jamshidi needle first, this from 2x femoral and 1x tibial sites . lab only seeing osteoblasts on this (As you suggested Malcolm). Survey rads had not shown anything and no globulinaemia so I went in for a surgical approach and removed the cystic structure lying over the Tibial crest, some solid tissue here right over the joint capsule. Just got preliminary results suggesting a synovial cell tumour or poss histocytic mass. Currently awaiting immunohistology decide which and determine my plan.

think we are heading for amputation which I am sure in days gone by I would have done before now. Feeling a bit as though I've performed unnecessary diagnostics but everybody seems to say better the devil you know before jumping into radical surgery. Hopefully the lab can grade the tumour before we proceed though.

thanks everyone.

RE: osteosarcoma?

Braden Collins — Mon, 07 Nov 2016 22:59:39 GMT

Thanks Malcolm. Great to have specialist input for these questions.

RE: osteosarcoma?

Hannah Wynne Richards — Mon, 07 Nov 2016 14:05:32 GMT

I've given Anthony 5*s so he's now on an average of 3

Wynne

RE: osteosarcoma?

Bob Russell — Mon, 07 Nov 2016 13:09:30 GMT

[quote user="Anthony Dennison"]

We've recently had a case of an older spaniel that went acutely lame after knocking his carpus against a step whilst coming in from the garden. No better with rest + NSAIDs, very little changes on radiographs (possible lytic lesion proximally on the middle two metacarpals but nothing obvious). Leg then became hugely swollen, starting at the carpus then up towards the elbow.

We took soft tissue biopsies around the carpus, came back as reactive mesenchymal proliferation. Eventually the owner opted for amputation as the dog was so bright apart from being NWB on his forelimb. Histo came back as a metastatic adenocarcinoma, with the primary elsewhere. Quite unexpected!

[/quote]

One star man hits again!

An interesting case, not unrelated to the post so who thinks it worth one star? If there is something wrong with the post why not comment properly?

RE: osteosarcoma?

Malcolm Ness — Mon, 07 Nov 2016 13:08:02 GMT

[quote user="Braden Collins"]

This might be a silly question but why an excision biopsy rather than a biopsy with a Jamshidi needle?

is it because the lesion is so extensive that the leg needs to come off either way?

[/quote]

Not a silly question. Needle biopsy techniques, even in the best hands, are associated with a significant risk of false negative due to sampling the wrong bit and/or expecting your pathologist to make a diagnosis on a very small piece of tissue.How big that risk becomes in less experienced hands sampling a deep tissue in an unfamiliar location is anybody's guess. See above example where obviously symptomatic metastatic disease was missed.

RE: osteosarcoma?

Braden Collins — Mon, 07 Nov 2016 12:41:26 GMT

[quote user="Malcolm Ness"]

[quote user="Evelyn Barbour-Hill"]Is it me, non-expert, or is the patella affected as well?[/quote]

I think the patella is affected too. This needs an excision biopsy. Plasmacytoma would be top of my list. Prognosis not very good but probably better than osteosarcoma.

[/quote]

This might be a silly question but why an excision biopsy rather than a biopsy with a Jamshidi needle?

is it because the lesion is so extensive that the leg needs to come off either way?

RE: osteosarcoma?

Anthony Dennison — Mon, 07 Nov 2016 10:33:35 GMT

RE: osteosarcoma?

Hannah Wynne Richards — Fri, 04 Nov 2016 08:38:35 GMT

Good old Malcolm. It's really useful having an input from specialists.

Wynne

RE: osteosarcoma?

Malcolm Ness — Fri, 04 Nov 2016 08:00:30 GMT

[quote user="Evelyn Barbour-Hill"]Is it me, non-expert, or is the patella affected as well?[/quote]

I think the patella is affected too. This needs an excision biopsy. Plasmacytoma would be top of my list. Prognosis not very good but probably better than osteosarcoma.

RE: osteosarcoma?

Evelyn Barbour-Hill — Thu, 03 Nov 2016 22:48:56 GMT

Is it me, non-expert, or is the patella affected as well?

RE: osteosarcoma?

dave reid — Thu, 03 Nov 2016 20:44:09 GMT

Thanks everybody, synovial mass was on my mind when I shoved a needle into it, think some chest x-Ray's and a better biopsy sample might be order of the day. (no cranial drawer and no pathology on the contra lateral stifle)

dog looks a bit on the big side to have been chasing any radioactive sheep recently though!

RE: osteosarcoma?

Utlendigur — Thu, 03 Nov 2016 18:46:46 GMT

[quote user="robloxley"]

Synovial sarcoma maybe?

I'd think a biopsy before lopping the leg off, and definitely some staging

[/quote]

Was thinking along same lines as lesions cross the joint space. Have also seen similar lesions in a cat that turned out to be a haemangiosarcoma within the stifle. (18mnth old cat with acute lameness and joint effusion but xray had several circular lytic lesions in joint margins and joint tap looked like pure blood). I blame Chernobyl and all these radio-active sheep

RE: osteosarcoma?

Rob Loxley — Thu, 03 Nov 2016 18:12:35 GMT

Synovial sarcoma maybe?

I'd think a biopsy before lopping the leg off, and definitely some staging

RE: osteosarcoma?

Richard Carter — Thu, 03 Nov 2016 17:40:12 GMT

agree with the lysis of bone in both distal femur and prox tibia. I think infection would have been obvious on your fna but the osteosarcs I have seen have always had some new periosteal bone formation.

A blood sample/ smear would show if you have osteomyelitis at this level I would have thought.

So - possibilities - your fna didn't pick up tumour cells eg connective tissue tumours because they don't slough? or the soft lump that produced the fluid is not the cause of the lesion but a consequence?

Chance of a biopsy punch or large needle core biopsy from the distal femur?

Any popliteal enlargement for fna?

RE: osteosarcoma?

Linda Filshie — Thu, 03 Nov 2016 17:37:03 GMT

Not an expert radiographer or orthopod but that doesn't look much like osteosarc to me. Not sure of the significance of the 'cystic' lesion on the tibial plateau but I assume you checked for cranial drawer? Painful on palpation at all?

RE: osteosarcoma?

dave reid — Thu, 03 Nov 2016 16:33:56 GMT

cr caud image of knee on here couldn't attach them both!