case_images: PMC10753991_01
case_images: X-ray, CT, and MRI images. (A) Osteoblastic destruction of the right sacroiliac joint with a periosteal reaction. (B) The local discontinuity in the bone cortex of the right sacroiliac joint before chemotherapy, along with osteogenic bone destruction, large surrounding soft tissue mass, and unclear boundaries. (C) The bone image of multiple lamellar tumors in the soft tissues after neoadjuvant chemotherapy, with obvious calcification. (D) An MRI after neoadjuvant chemotherapy revealed a small local soft tissue mass and reduced peripheral inflammatory response.
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case_images: The pelvic radiograph showed osteoblastic destruction of the right sacroiliac joint with periosteal reaction and a high probability of malignant bone tumor ( Figure 1A ). A computed tomography (CT) scan revealed an irregular bone destruction area in the right sacroiliac joint and a large soft tissue mass with unclear boundaries ( Figure 1B ). CT repeated after chemotherapy revealed patellar high and low mixed density in the right iliac bone, mass formation of surrounding soft tissues, multiple lamellar tumor bones in the soft tissue, and obvious calcification ( Figure 1C ). Magnetic resonance imaging (MRI) exhibited a small local soft tissue mass and reduced surrounding inflammatory responses ( Figure 1D ).
case_images: Lung CT, operative photograph, tumor specimen, X-ray, and pelvic CT after surgery. (A) The lung CT scan results of the patient at the first admission. (B) The lung CT plain scan results of patients admitted for chemotherapy in sequence. (C) The lung CT plain scan results of the patient on September 5, 2023. Lung CT showed no abnormal density in both lungs. (D) The tumor was completely resected, pedicle and iliac nails were inserted, and titanium cages were placed. (E) Completely resected tumor tissue. (F) Partial bone loss in the right ilium and sacrum, with metal fixation in the corresponding areas. (G) Partial absence of the right sacral wing, ilium, gluteus, and iliac muscles on pelvic CT, with metal fixation shadows visible in the right sacral ilium and numerous radiating artifacts around them.
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case_images: Lung CT displayed no significant visceral metastasis ( Figure 2A ). On November 14, 2018, tumor resection and reconstruction with screw rod fixation were performed ( Figures 2D, E ). Local plain radiography and CT were conducted regularly during chemotherapy ( Figures 2F, G ), and no recurrence or distant metastasis was noted ( Figure 2B ). Tumor Society (MSTS), was 19. The patient was diagnosed with osteosarcoma in 2018, but no signs of lung metastasis were observed ( Figure 2C ).
case_images: Pathology images. (A) A pathological image captured with an optical microscope at x200 magnification and an image in which some heterotypic cell components were detected in the tissues, some cells showed abundant cytoplasm, and some areas were necrotic; these observations are consistent with the chondroblast-type osteosarcoma. (B) A pathology image of a post-recurrence puncture captured with an optical microscope at x200 magnification and an image in which the chondrosarcomatoid components were detected. (C) A pathological image showing the puncture at the end of multimodal combination therapy, as captured with an optical microscope at x200 magnification and an image in which the tissue submitted for examination was striated muscle-grade fibrous adipose tissues, with no tumor cells detected.
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case_images: Postoperative pathology confirmed that the patient had chondrocyte osteosarcoma ( Figure 3A ), and the tumor necrosis rate was approximately 90%, consistent with the post-chemotherapy response and Huvos rating system Grade III. Figure 3B ), which indicated local recurrence. Following recurrence, if the tumor is large and is located close to abdominal organs, R0 resection cannot be performed with the limb preserved. Pathological examination revealed both the striated muscle and fibroadipose tissue ( Figure 3C ).
case_images: X-ray, contrast-enhanced CT, and radiation dose segmentation diagram and MRI images. (A) An abnormally low-density shadow within the right gluteus maximus with an unclear boundary. (B) Irregular T2 signals in the right residual muscle with unclear boundary. (C1, 2, 3) The enhanced CT scan of the patient's pelvis before radiotherapy, with the red arrow indicating the mass. (D1, 2, 3) The dose segmentation of radiotherapy. (E1, 2, 3) The enhanced CT of the pelvis at the end of multimodal therapy, indicating no tumor tissues.
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case_images: X-ray showed an abnormally low-density shadow within the right gluteus maximus with an unclear boundary ( Figure 4A ). Enhanced CT revealed that the soft tissue tumor was large in volume, with unclear boundaries, was of low density, and exhibited uneven edge enhancement and abundant internal blood flow ( Figure 4C ). MRI showed irregular signals in the right residual muscle with a maximum cross-sectional area of 3.8 x 2.2 cm, and the boundary was not clear ( Figure 4B ). Combined with intensity-modulated radiotherapy (IMRT), a total dose of 60 Gy equivalents (300 cGy/time, 20 times in total) was administered over 4 weeks, which resulted in local control ( Figure 4D ). Contrast-enhanced CT revealed no obvious soft tissue mass ( Figure 4E ).