Concluded Case

Solitary Pulmonary Nodule

A 18-years old female diagnosed to have osteosarcoma left lower limb underwent mid-thigh amputation followed by adjuvant chemotherapy, presents with an solitary nodule in the left apicoposterior segment of the upperlobe. No exthoracic uptake noted in the PET. Localisation of nodule was performed with fluoresin stain under C arm before the incision by intensive care specialist She underwent Uniportal Vats left upperlobe metatasectomy under double lumen intubation. Kindly comment on diagnosis and further management. Chest xray, PET scan, intraoperative and gross specimen pics attached.

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Concluded answer

Possibly Pulmonary metastatic osteosarcoma. Needs to see for primary. Adv to wait for HPE report. Oncologist reference .

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Pure case of osteosarcoma of left lower limb Sometimes metastasis is not picked up on pet scan Very valid point Definitely on xray mass is seen Opinion of oncologist

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Possibly Pulmonary metastatic osteosarcoma. Needs to see for primary. Adv to wait for HPE report. Oncologist reference .

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Radiological findings suggest secondary in left lung for which metastatectomy was done.Most probably the Biopsy specimen goes in favor of malignancy and second line of Chemotherapy is choice of treatment. In some of advance centers local brachy radiotherapy also tried. In most of the Oncology centers Tumor Boad will decide the policy of treatment.

Question- Why did the patient get adjuvant chemotherapy for osteosarcoma. Usually one would do neoadjuvant as response to therapy is a very strong predictor of risk of metastasis. Do you know if the patient got MAP or MAP/IE How long between surgery and this nodule? solitary metastasectomy can provide long term survival, however one needs to closely watch for recurrence. If this was the only site, and the margins were clear on resection, would consider observation only at this time.

It is a metastatic lesion of primary osteosarcoma Way out is chemotherapy only

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