VOLUME 16 - NUMBER 2 / March - April (Clinical case / Caso clínico)
Miguel Ángel Clara-Altamirano, Ortopedista Oncólogo adscrito al Departamento de Piel y Partes Blandas, Instituto Nacional de Cancerología, Ciudad de México, México
Dorian Yarih García-Ortega, Cirujano Oncólogo adscrito al Servicio de Piel y Partes Blandas, Instituto Nacional de Cancerología, Ciudad de México, México
Alejandro Maciel-Miranda, Cirujano Plático adscrito al Servicio de Piel y Partes Blandas, Instituto Nacional de Cancerología, Ciudad de México, México
Héctor Martínez-Said, Cirujano Oncólogo adscrito al Servicio de Piel y Partes Blandas, Instituto Nacional de Cancerología, Ciudad de México, México
Jorge Luis Martínez-Tlahuel, Servicio de oncología Medica, Instituto Nacional de Cancerología, Ciudad de México, México
Claudia Haydee Sarai Caro-Sánchez, Patóloga Oncóloga adscrita al Servicio de Patología Quirúrgica, Instituto Nacional de Cancerología, Ciudad de México, México
Mario Cuellar-Hubbe, Cirujano Oncólogo, Jefe de Servicio de Piel y Partes blandas, Instituto Nacional de Cancerología, Ciudad de México, México
Introduction: Dedifferentiated parosteal osteosarcoma is a variant where a highgrade osteosarcoma coexists with a parosteal osteosarcoma. Clinical Case: A 20-year-old female patient presented with a 6-month history of right forearm pain and functional limitation, with no apparent cause. X-rays revealed a right ulnar diaphysis tumor lesion. On physical examination, there was pain on palpation at right ulna diaphysis and pronosupination limitation. Chest computed axial tomography showed metastatic disease to the left lung upper lobe. An incisional biopsy of the right ulna tumor reported a dedifferentiated parosteal osteosarcoma. Neoadjuvant chemotherapy with cisplatin and doxorubicin management was therefore started until 3 cycles were completed. Surgical treatment involved right ulna diaphysis intercalary resection plus microvascularized autologous right fibula diaphysis graft reconstruction and graft stabilization with a 3.5-mm DCP plate and a one-third tubular plate. In the same procedure, pulmonary metastasectomy was carried out by thoracoscopy. Postsurgical histopathological examination reported 100% necrosis. Currently, the patients is asymptomatic and with no evidence of tumor activity. Conclusion: Dedifferentiated parosteal osteosarcoma is a rare condition, but it should be suspected as differential diagnosis when a parosteal osteosarcoma is found. The fact that this condition can generate metastasis owing to its dedifferentiated pattern should be taken into account. It is important to plan a surgical treatment that enables appropriate functional reconstruction, always taking into account the oncologic principle.
Keywords: Dedifferentiated parosteal osteosarcoma. Intercalary resection. Microvascularized autologous graft.
