PMC6488563_01
Preoperative Clinical State. A. Initial state, B. Post neoadjuvant chemotherapy.
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After several diagnostic trials, the patient visited our center to seek advice about her telangiectatic osteosarcoma (Fig. 1A). Clinically the mass was not getting bigger compared to before chemotherapy (Fig. 1B).
Anteroposterior and Lateral Radiograph of Humerus. A. Initial state, B. Post neoadjuvant chemotherapy.
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From humerus X-ray, there was mixed lesions along the humerus with pathological fracture on the midshaft (Fig. 2A). From x-ray, the mixed lesions became more marked compared to the previous x-ray (Fig. 2B).
MRI of the humerus. A. Initial state, B. Post neoadjuvant chemotherapy.
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T2-weighted MRI showed iso-hyperintense and expansile lesions along the humerus (Fig. 3A). MRI showed that the mass was slightly became larger compared to the previous MRI with no involvement of neurovascular bundle (Fig. 3B).
Intraoperative. A. Endoprosthetic assembly, B. Bone Cement and mesh used, C. Resected Humerus.
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Extension cerclage wire was used to make the implant as one unit (Fig. 4A). Prolene mesh then was sheathed to the bone cement, and then the preserved rotator cuff tendons and biceps and triceps muscle were sutured back with the Ethibond sutures (Fig. 4B). The resected tumor and humerus were then sent to the lab for histopathologic analysis (Fig. 4C).
Postoperative radiograph.
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From the post-operative x-ray, the modified prosthesis sat well on the shoulder and elbow joint (Fig. 5).
Histopathologic Examination of the Lesion.
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Post-operative histopathological examination showed telangiectatic osteosarcoma with HUVOS IV (Fig. 6).
3 Years follow up.
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Patient's shoulder abduction and elbow flexion was shown on the pictures (Fig. 7).