Fine needle aspiration of osteogenic sarcoma metastatic to the lung. A report of four cases.

BACKGROUND: Osteogenic sarcoma (OGS) is a relatively rare, highly malignant neoplasm of bone with a tendency to metastasize to the lung. Resection of pulmonary metastases in selected instances can increase survival and likelihood of a cure. To date, fine needle aspiration (FNA) of OGS had been well characterized in primary sites of bone and soft tissue. CASES: Four patients with a history of OGS presented with lung nodules suspected to be metastatic disease. All were evaluated initially by radiographically assisted FNA. In all cases FNA showed spindled or osteoblastlike cells. Two cases demonstrated stromal elements: chondroid or osteoid matrix in one case each of chondroblastic and conventional OGS. All four cases had histologic confirmation of metastatic OGS in the form of subsequent surgical resection of the lung nodules. CONCLUSION: New pulmonary nodules in a patient with known malignancy is almost always metastatic disease. In a patient with a history of OGS, the diagnosis is extremely likely to be metastatic OGS, but a few other entities may occur. Although these entities are rare, their occasional occurrence could argue for preoperative confirmation of the lung lesion as malignant prior to subjecting the patient to pulmonary resection. Our findings show FNA features of OGS that have been previously observed in primary sites. These findings are specific enough to diagnose metastases if the patient has known primary OGS.

Duke Scholars

Author Leslie Gail Dodd Pathology

Author Holman Page McAdams Radiology, Cardiothoracic Imaging