Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2017; 9(2): 68-72
Published online Feb 27, 2017. doi: 10.4240/wjgs.v9.i2.68
Giant abdominal osteosarcoma causing intestinal obstruction treated with resection and adjuvant chemotherapy
Alexandros Diamantis, Grigorios Christodoulidis, Dionysia Vasdeki, Foteini Karasavvidou, Evangelos Margonis, Konstantinos Tepetes
Alexandros Diamantis, Grigorios Christodoulidis, Dionysia Vasdeki, Evangelos Margonis, Konstantinos Tepetes, Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, 41110 Thessaly, Greece
Foteini Karasavvidou, Division of Anatomic Pathology, University Hospital of Larisa, Mezourlo, Larisa, 41110 Thessaly, Greece
Author contributions: All authors contributed to the acquisition of data, writing and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at the University General Hospital of Larisa.
Informed consent statement: The patient involved in this report gave his verbal consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos Tepetes, MD, ScD, FACS, FEBS (Surgical Oncology), Professor and Head of General Surgery, Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, 41110 Thessaly, Greece. tepetesk@gmail.com
Telephone: +30-2413-502803 Fax: +30-2413-501559
Received: October 3, 2016
Peer-review started: October 8, 2016
First decision: November 14, 2016
Revised: December 4, 2016
Accepted: December 28, 2016
Article in press: December 28, 2016
Published online: February 27, 2017
Abstract

Extraskeletal osteosarcoma (ESOS) is an uncommon tumor that accounts for 1% of all soft tissue sarcomas and 4% of all osteosarcomas. Its presentation may be atypical, while pain has been described as the most common symptom. Radiological findings include a large mass in the soft-tissues with massive calcifications, but no attachment to the adjacent bone or periosteum. We present the case of a 73-year-old gentle man who presented with a palpable, tender abdominal mass and symptoms of bowel obstruction. Computer tomography images revealed a large space-occupying heterogeneous, hyper dense soft tissue mass involving the small intestine. Explorative laparotomy revealed a large mass in the upper mesenteric root of the small intestine, measuring 22 cm × 12 cm × 10 cm in close proximity with the cecum, which was the cause of the bowel obstruction. Pathology confirmed the diagnosis of an ESOS. ESOS is an uncommon malignant soft tissue tumor with poor prognosis and a 5-year survival rate of less than 37%. Regional recurrence and distant metastasis to lungs, regional lymph nodes and liver can occur within the first three years of diagnosis in a high rate (45% and 65% respectively). Wide surgical resection of the mass followed by adjuvant chemotherapy or radiotherapy has been the treatment of choice.

Keywords: Osteosarcoma, Sarcoma, Extraskeletal, Intestinal obstruction, Abdominal mass, Soft tissue

Core tip: We present the case of an elderly man who presented with a palpable abdominal mass and signs of intestinal obstruction. Intra-operative findings revealed a mass in the right abdomen involving the small intestine, which was widely resected. A diagnosis of soft tissue osteosarcoma was confirmed by pathology; further treatment with chemotherapy followed. To our knowledge it has never been reported a case of abdominal obstruction due to soft tissue sarcoma in the literature. Due to its rarity, we strongly believe that the presentation of this case would contribute to further understanding of the biology and management of this tumor.