A Rare Tumor With an Exuberant Metastasis

Periosteal osteosarcoma (PO) consists of a rare primary malignant bone tumor, corresponding to less than 2% of all osteosarcomas.¹ The most common bones involved are tibia and femur. Surgical excision remains the cornerstone of treatment but PO presents a higher incidence of secondary malignancies, with lung metastases being the most common ones.^1,2 Dypnoea is a frequent symptom in palliative conditions.

The authors present a case of a 32-year-old man with PO admitted to emergency room (ER) with symptoms of prostration, dyspnea and generalized edema. His past medical history included a PO of the distal end of the right femur submitted to an enlarged resection and femoro-popliteus bypass and chemotherapy 3 years ago with local recurrence and extensive pulmonary metastasis, under palliative care, 2 months before going to the ER.

A chest radiography (Fig. 1A) evidenced extensive bilateral opacities occupying almost the entire pulmonary field, bilaterally. The CT Pulmonary Angiogram (Fig. 1B–D) showed pulmonary thromboembolism and bulky and numerous peripheral nodular densifications (maximum diameter of 13 cm). The following diagnoses were assumed: extensive pulmonary metastasis of the PO of the distal end of the right femur; global respiratory failure with respiratory acidosis and pulmonary thromboembolism.

Fig. 1.

Chest radiography (A) and a computed tomographic pulmonary angiography (coronal – B and axial planes – C/D) that evidence an extensive and exuberant pulmonary metastasis.

Non Invasive Ventilation was used as a palliative strategy, being an effective option in reducing breathlessness in advanced cancer.

Authors’ contributions

Patrícia Varela Ramos conceptualized and constructed the manuscript. Ana Ferreira Alves, Antonio M. Esquinas and Ângela Simas contributed to manuscript development. All authors critically reviewed and revised the manuscript draft and approved the final version for submission.

Informed consent

This consent has been obtained.

Funding

The authors have no funding information to declare.

Conflicts of interest

Authors have no conflict of interest to declare. Authors have no relevant financial or non-financial interests to disclose.

Acknowledgments

Filipe Patrocínio, MEng that provided writing assistance and proofreading the article.