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ABSTRACT: The presence of lymph node metastases from osteosarcoma was rare at diagnosis, occurring in only four of 176 patients (2.3%) at St. Jude Children's Research Hospital. An additional patient presented with calcified lymph nodes, which were demonstrated to contain no evidence of metastatic osteosarcoma. These patients did not differ in race, sex or age at diagnosis from other osteosarcoma patients. Each of the four patients with lymph node metastases of osteosarcoma had tumors composed predominantly of the osteoblastic type. Regional nodal metastases, whether alone or in conjunction with other metastatic disease, were a poor prognostic factor. Despite aggressive therapy, median survival was 8 ½ months from diagnosis, which did not differ significantly from the survival achieved by other osteosarcoma patients who had other hematogenous metastases. Key indexing terms: Osteosarcoma; Metastasis; Lymph nodes.
Introduction
Osteosarcoma represents the most common primary malignant bone tumor in the first two decades of life.1 The most significant prognostic factor has been the presence of pulmonary metastases at diagnosis.2 Before the use of adjuvant chemotherapy, lung metastases appeared within five to six months of diagnosis and extrapulmonary metastases usually occurred after nine to ten months.2 About 15% of patients have pulmonary metastases at the time of diagnosis. Hematogenous spread of osteosarcoma represents the major route of dissemination, while lymph node metastases are relatively uncommon.
The purpose of this paper is to present and discuss five osteosarcoma patients seen at St. Jude Children's Research Hospital who had calcified lymph nodes at the time of diagnosis of the primary tumor of the skeleton.
Subjects and Methods
Index Case
A white boy presented at 13.9 years of age with intermittent throbbing pain in the right forearm of fours weeks' duration. He related the onset of this pain to a football injury. The pain was severe enough to limit his activity and often awakened him from sleep. When the pain persisted, a roentgenograph was obtained; this demonstrated a sclerotic lesion of the right distal radius. Physical examination revealed slight swelling of the right distal forearm, decreased range of motion at the wrist, and three I cm to 2 cm firm right axillary nodes. Blood chemistries were normal except for an elevated alkaline phosphatase of 1 ,068 UiL (normal: 280 to 850). A...