Esophagus
Other malignancies
Osteosarcoma

Author: Feriyl Bhaijee, M.D. (see Authors page)
Editor: Israh Akhtar, M.D.

Revised: 1 February 2018, last major update November 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Osteosarcoma esophagus

Cite this page: Bhaijee, F. Osteosarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusosteosarcoma.html. Accessed August 16th, 2018.
Definition / general
  • Malignant mesenchymal neoplasm characterized by neoplastic cells that produce osteoid matrix
  • Also called osteogenic sarcoma, extraosseous osteosarcoma
  • Subtypes: osteoblastic, chondroblastic, fibroblastic, MFH-like, telangiectatic, well differentiated
  • See also bone chapter
Epidemiology
  • Extremely rare in esophagus: only 3 histopathologically confirmed cases reported
  • Metastatic osteosarcoma to esophagus is more common
Clinical features
  • Intramural mass, stricture, perforation
  • Obstructive symptoms: dysphagia, odynophagia, nausea and vomiting
Radiology description
  • Highly variable radiographic appearance
  • High grade tumors are usually large, poorly defined, destructive
  • CT may show calcified, lobulated mass (Sarcoma 2010;2010:907127)
Radiology images

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Lobulated calcified esophageal mass at T4

Prognostic factors
  • High grade tumors are aggressive with high morbidity and mortality
Case reports
Treatment
  • Surgery and chemotherapy
Clinical images

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Large intraluminal polypoid tumor

Severe stricture

Gross description
  • Conventional osteosarcoma: infiltrative with foci of hemorrhage, necrosis, cystic degeneration
Gross images

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Microscopic (histologic) description
  • Highly variable microscopic appearance
  • Malignant cells deposit coarse, lace-like osteoid matrix (neoplastic bone), which is eosinophilic, homogeneous, glassy
  • Tumor cells may be spindled, oval or round and of variable size
  • May include malignant fibroblastic or cartilaginous elements
  • Vascular invasion, hemorrhage, necrosis are common
Microscopic (histologic) images

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Giant osteoblast cells

Chondroblastic osteosarcoma

Epithelioid osteosarcoma


Osteoblastic osteosarcoma

Small cell osteosarcoma

Telangiectatic osteosarcoma

Keratin negative

Cytology description
  • Cellular smears of discohesive / single cells, which may be spindled, oval, epithelioid or plasmacytoid
  • Background osteoid matrix
Cytology images

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Osteosarcoma in a dog

Positive stains
Negative stains
Electron microscopy description
  • Differentiated tumor cells resemble osteoblasts: abundant dilated endoplasmic reticulum, rare mitochondria
  • Osteoid matrix comprises nonperiodic fibrils, scattered collagen fibers and hydroxyapatite calcium crystals
Electron microscopy images

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Site unspecified

Molecular / cytogenetics description
  • Lacks Ewing sarcoma associated t(11;22) and synovial sarcoma associated t(X;18) translocation variants
Differential diagnosis