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Weekly Chest CasesArchive of Old Cases

Case No : 590 Date 2009-02-16

  • Courtesy of Kun Young Lim, MD, Hyae Young Kim, MD, Soo Hyun Lee, MD. / National Cancer Center, Korea.
  • Age/Sex 49 / F
  • Chief ComplaintPalpable mass on left chest wall
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Radiation-induced extraskeletal osteosarcoma
Radiologic Findings
Fig 1. Chest radiograph shows increased opacity in left upper lung field. The patient has history of bilateral mastectomy.
Fig 2. Non-contrast HRCT shows ossifying mass in left pectoralis muscle.
Fig 3. Lung window setting of the HRCT scan shows fibrotic change in apex of both upper lobes suggesting radiation fibrosis.
The patient received left mastectomy and radiation therapy with a total dose of 5040cGy due to breast cancer 13 years ago. She also received right mastectomy and radiation therapy with a total dose of 6400cGy 8 years age.
Brief Review
Radiation-associated sarcoma is a rare but well-known late complication of radiotherapy with a incidence of 0.035% to 0.8%. Generally, a minimum dose of 10?6Gy is postulated to be necessary to induce this complication. The mean latency period is 10?5 years.

The criteria for the diagnosis of postirradiation sarcoma was first proposed by Cahan et al. in 1948 and consisted of (1) history of radiation therapy, (2) sarcoma arising within the radiation field after the radiation has been given, (3) long latency period, and (4) histologic confirmation of the sarcoma.

The long-term risk of developing sarcoma after radiation therapy for breast cancer has been reported as 0.2% for 10 years. The most common soft tissue sarcoma and bone sarcoma to arise in the irradiated conserved breast and the surrounding field are angiosarcoma and osteosarcoma, respectively. Most reported cases of osteosarcoma of the chest wall following irradiation for breast cancer arise from the chest wall skeletal structures.

Radiation-associated extraskeletal osteosarcomas (ESOSs) are reported to range from 3.8% to 10% of all ESOSs and 13% of all radiation induced sarcomas. Extraskeletal osteosarcomas have a local recurrence rate of 26% to 69%, with a 5-year survival rate of 25% to 37%. Survival does not seem to be affected by latency period, location, amount of radiation, or histologic type.
References
1. Orta L, Suprun U, Goldfarb A, et al. Radiation-associated extraskeletal osteosarcoma of the chest wall. Arch Pathol Lab Med 2006; 130: 198-200
2. ninimiya H, Miyoshi T, Shirakusa T, et al. Postradiation sarcoma of the chest wall: report of two cases. Surg Today 2006; 36: 1101-1104
Keywords

No. of Applicants : 88

▶ Correct Answer : 6/88,  6.8%
  • - KONARK DIAGNOSTIC CENTRE , India AHAMAD MUKARRAB
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Mediacl IT Consulting , Japan Kazumasa Nishimura
  • - Ewha Womans University , Korea (South) Ha Eun Ju
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - clinique de SAVOIE , France, Metropolitan gay depassier philippe
▶ Correct Answer as Differential Diagnosis : 1/88,  1.1%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
▶ Semi-Correct Answer : 42/88,  47.7%
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - MD Nanavati Hospital,Mumbai, INDIA , India Sushant Bhadane
  • - hospital Sao Paulo , Brazil israel missrie
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - john h stroger hsp , United States dheeraj reddy gopireddy
  • - oswal hospital , India harpreet saini
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Ruby Hall Clinic , India john joseph
  • - CHR ANNECY , France Olivier Segall
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - CHRU lille , France manuel toledano
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Osaka University , Japan Osamu Honda
  • - SMC , Korea (South) Jihoon Cha
  • - Institute of Chest Diseases,Calicut , India sijith raghavan
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - McGill University Health Center , Canada Alexandre Semionov
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - Yashoda Super Speciality hospital , India Ramesh Pandey
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - EKH-Berlin , Germany Michael Weber
  • - DCA, , India Rajesh Gothi
  • - yashodha hospital , India pravin mahadevappa
  • - ASL BOLOGNA - MAGGIORE HOSPITAL- ITALY , Italy MARCELLINO BURZI
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - NOUR EL-ISLAM RADIOLOGY CENTER , Egypt Elsayed Mousa
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - NASA SCANS , India RAKESH BHATIA
  • - CH Sud Rnion , Reunion jean-baptiste Noel
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - IRSA , France jean BIGOT
  • - CHU Grenoble , France Fabrice Bing
  • - Armed Forces Chun-Cheon Hospital , Korea (South) Chaehun Lim
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