"Osteosarcoma"

1. CASE
PRESENTATION
ON

2. Presenting By-
Dr. Golam Muhamud (Suhash).
Prepared By-
Dr. Md Nazrul Islam
MBBS, M .sc. (B M E).

7. • She has h/o wt. loss, and loss of appetite but she has /had
no complaints of pain, swelling and deformity in other parts
of the body. She has no history of cough , haemoptysis, DM ,
HTN and asthma.
• With these complaints she got herself admitted into Shaheed
Suhrawardy Medical college Hospital for better management.

8.  She had no history of tuberculosis.
Drug history:
• H/O taking analgesic for 3 months
but could not mentioned the name
of drugs.

9. None of her family member suffered from
such illness.
Personal history:
Nothing contributory

10. • MP-4 to 6 days
• MC-regular
• Age of menarche-13yrs.

11. Immunized against –
Tuberculosis
& Tetanus

12. • Appearance- Ill looking
• Body builds- Below average
• Co-operation- Co-operated
• Decubitus- Supine
• Anaemia- Moderate
• Jaundice- Absent
• Cyanosis- Absent
• Clubbing- Absent
• Koilonychia-Absent
• Lekonychia- Absent
• Lymph nodes- Not palpable
• Dehydration- No sign
• Pulse - 84 Beat/min
• Blood pressure- 100/60mm of Hg
• Temperature-normal
• Respiratory rate-16/min

13. Look-

15. Fluctuation test- negative,
Trans-illumination test-negative,
Patellar tap test- negative.
Shortening of limb - 3 cm.
Muscle wasting-
Thigh – 4 cm.
Leg – 2 cm
 Distal neurovascular status- normal
 Regional lympnodesnot enlarged.

16. Movement:
 walk with support.
 Left knee (ROM)–
• Active flexion -Absent
• Active extension-Absent
• Patellar movement-Absent
 Left hip & ankle: normal range of
movement

17. Locomotor system
Gait: Can walk with support
Inspection:Flexion attitude-
Left knee(20 degree)
Palpation: Tenderness – affected area.
Spine: Normal

18. Higher psychic function: Normal
Cranial Nerve examination: Normal
Motor function:
Inspection:
Gross Muscle wasting in left thigh &
leg.

21. Deep tendon reflex:
All jerks are present & normal
Sensory function test:
All the sensory functions are normal.

22.  Inspection: Normal in size & shape of the chest-
Respiratory rate: 16 /min
 Palpation: Trachea centrally placed, normal chest
expansibility
 Percussion: Resonant all over the chest except right
upper, middle and lower zone where dullness is present.
 Auscultation: Bronchial breathing sound with diminished
breathing sound in Rt. Upper middle and lower zone.

23.  Pulse: 84 bts/ min
 B.P. 110/60 mm of Hg
 JVP: Not raised.
 Inspection: NAD
 Palpation: Apex beat in Lt 5thintercostal space,
 Percussion: superficial cardiac dullness presence over the precordium.
 Auscultation: s1& s2 is audible

24. • Inspection: nothing abnormality detected
• Palpation: soft, non tender
• Percussion: tympanic
 Auscultation: bowel sound present
 Per-rectal examination: normal findings.

25. Ms. Fatema, 18 years ill-looking, moderately anaemic,
non icteric, nondiabetic, normotensive woman coming
from Mirpur, Dhaka admitted in ShaheedSuhrawardy
Medical College Hospital with thecomplaints of –
• pain, just above the left knee joint 3 months back ,
• swelling above the left knee joint 2 months back and
• inability to walk for 1month.

26. • The pain was initially mild , fixed, non
radiating, aching in nature but gradually it
becomes intolerable which was aggravated
during walking and worse at night &
incompletely relived by taking
NSAIDs.Thispain was not associated with
fever.
• She also noticed an ill defined swelling above
left knee joint which was initially.

27. Small in size then it increases rapidly to a
large size.It is associated with pain but not
related to trauma.
• She also gives H/O inability to walk due to
pain,swelling and restriction of movement.
• She gives H/O wt loss,loss of appetite but
she has no H/O pain,swelling,deformity in
other parts of body.

28. • On local examination- an ill defined diffuse
swelling occupying over the supracondylar region
of the left thigh with shiny skin and presents of
engorged vein and wasting of the thigh and leg.
• She has a deformity of knee and cannot walk
without support.

29. • The surface of swelling smooth, margin- ill-
defined, local temperature-raised ,
tenderness present, over lying skin is free,
consistency-hard, not movable and fixed with
underlying structure.
• Shortening of the left limb was found 3 cm
than the right. She was unable to walk
without support.

30. • There was gross muscle wasting in left Lower limb,
measuring thigh- 4cm, leg- 2 cm.
• Neuromuscular status of left lower limb normal and
regional lympnodes are not enlarged.Movement of the
left knee joint absent hip and spine are normal.
• On respiratory system examination-there was a
dullness in Rt upper and lower zone of lung and breath
sound also diminished in same area.Other system
examination reveals no abnormality.

37. • Extensive bone destruction is seen in
the left lower femoral shaft, condyles
and tibialcondyles with soft tissue
extension.
• peripheral calcification also seen.
• Bone destruction also seen in L5
vertebra.

38. Multiple metastatic nodules in both lungs along with
Rt. Sided Hydro-pneumothorax-

40.  S. creatinine 0.6 mg/ dl
 Blood urea 30 mg / dl
 S. calcium 7.5 mg / dl
 S. alkaline phosphates 110 IU/ L
 SGPT:26 IU/L , SGOT :33 IU/L
 S. bilirubin:1.0 mg/dl
• FNAC- Sarcomatous leison,suggestive of osteosarcoma.
• Biopsy (incisional): Feature of osteosarcoma with osteod
formation and many giant cells.