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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| A Painless Mass in the Hand (continued) |
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| Answer: Extraskeletal osteosarcoma of the hand. | ||
 Fig. 1-A |  Fig. 1-B | For larger view, click on image |
| Fig. 1-A Posteroanterior radiograph of the left hand, demonstrating a mass with central ossification located in the first web space. Fig. 1-B Lateral radiograph showing that the mass has not adhered to the underlying skeleton. There is no periosteal reaction or osseous destruction in the adjacent skeleton. |
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 Fig. 2-A |  Fig. 2-B | For larger view, click on image |
| Fig. 2-A Axial T1-weighted spin-echo magnetic resonance image (repetition time, 650 msec; echo time, 18 msec) showing a large soft-tissue mass, located within the thenar muscles, with heterogeneous signal intensity. The center of the mass has regions of very low signal intensity, representing areas of ossific matrix (arrowheads). Palmarly, the tumor has infiltrated muscle (arrow). Fig. 2-B Axial T2-weighted fast-spin-echo magnetic resonance image (repetition time, 5500 msec; echo time, 100 msec) demonstrating peripheral high signal intensity corresponding to the tumor (white arrowheads) and low signal intensity centrally, in the ossified region (black arrowheads). |
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 Fig. 2-C |  Fig. 3 | For larger view, click on image |
| Fig. 2-C Gradient-recalled-echo coronal magnetic resonance image (repetition time, 900 msec; echo time, 12 msec; and flip angle, 20°) demonstrating the extent of the tumor. Fig. 3 High-power photomicrograph of the biopsy specimen, demonstrating marked nuclear and cytological pleomorphism (hematoxylin and eosin, ×250). |
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| Discussion | ||
| Osteosarcomas rarely occur in the hand2. This primary neoplasm of bone may be classified, on the basis of its origin, as central, juxtacortical, or extraskeletal. Extraskeletal osteosarcomas are extremely rare and, although their true prevalence is unknown, it has been estimated that they account for approximately one in twenty-five (twenty-six of 650)3 reported cases of primary osteosarcoma of bone. | ||
| Extraskeletal osteosarcomas are located in the soft tissues without skeletal or periosteal attachment, and they have a uniform sarcomatous pattern and a matrix composed of osteoid or cartilage, or both. In contradistinction to primary osteosarcoma of bone, this variant typically develops after the fourth decade of life3 and the prognosis is uniformly poor3-11. | ||
| References | ||
| 1. Cook PA, Murphy MS, Innis PC, Yu JS. Extraskeletal osteosarcoma of the hand. A case report. J Bone Joint Surg Am. 1998;80:725-9. 2. Okada K, Wold LE, Beabout JW, Shives TC. Osteosarcoma of the hand. A clinicopathologic study of 12 cases. Cancer. 1993;72:719-25. 3. Allan CJ, Soule EH. Osteogenic sarcoma of the somatic soft tissues. Clinicopathologic study of 26 cases and review of literature. Cancer. 1971;27:1121-33. 4. Bane BL, Evans HL, Ro JY, Carrasco CH, Grigon DJ, Benjamin RS, Ayala AG. Extraskeletal osteosarcoma. A clinicopathologic review of 26 cases. Cancer. 1990;65:2762-70. 5. Boyer CW Jr, Navin JJ. Extraskeletal osteogenic sarcoma. A late complication of radiation therapy. Cancer. 1981;48:1256-61. 6. Chung EB, Enzinger FM. Extraskeletal osteosarcoma. Cancer. 1987;60:1132-42. 7. Enzinger FM, Weiss SW. Osseous tumors and tumorlike lesions of soft tissue. In: Soft Tissue Tumors. St. Louis: C. V. Mosby; 1983. p 720-44. 8. Fine G, Stout AP. Osteogenic sarcoma of extraskeletal soft tissues. Cancer. 1956;9:1027-43. 9. Lee JS, Fetsch JF, Wasdhal DA, Lee BP, Pritchard DJ, Nascimento AG. A review of 40 patients with extraskeletal osteosarcoma. Cancer. 1995;76:2253-9. 10. Rao U, Cheng A, Didolkar MS. Extraosseous osteogenic sarcoma: clinicopathological study of eight cases and review of literature. Cancer. 1978;41:1488-96. 11. Sordillo PP, Hajdu SI, Magill GB, Golbey RB. Extraosseous osteogenic sarcoma. A review of 48 patients. Cancer. 1983;51:727-34. |
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