Periosteal osteosarcoma arising from clavicle is extremely rare with only two cases documented in English literature.
Diagnosis based on the relation of clinical symptoms, radiology and histology.
Current treatment included neo-adjuvant chemotherapy and wide resection of the tumor.
Total claviculectomy without reconstruction can achieved good oncological and functional outcome.
Introduction: Osteosarcomas arising from the bone cortical surface can be subdivided into parosteal, periosteal, and high-grade surface osteosarcoma. Periosteal osteosarcoma is a rare primary malignant bone tumor arising from the surface of long bones, especially femur and tibia, comprising 4 % of all osteosarcomas. It is an intermediate-grade tumor, and current treatment includes adjuvant chemotherapy and wide tumor resection with limb-salvage surgery. Clavicle is extremely unusual site of periosteal osteosarcoma with only two cases documented in English literature. We report the third case of periosteal osteosarcoma of the clavicle in English literature. In case of primary malignance tumor rising from clavicle, total claviculectomy without reconstruction can be a good treatment option in term of oncology and functional regardless of some shoulder disabilities.
Case reports: A 20-year-old female presented with a less pain mass over her right clavicle. Diagnosis of clavicular periosteal osteosarcoma was made based on clinical features, radiology and histology. Treatment included neoadjuvant chemotherapy by Doxorubicin-Cisplatin followed by tumor wide resection and total claviculectomy. Patient received 3 episodes of chemotherapy with the same agent postoperative. Postoperative course was uneventful. Followed up at 32nd month, the wound heal completely. There is no sign of local recurrence or metastasis. Patient can back to previous works and daily activities with little or no restriction, Constant score of right shoulder is 81.
Discussion and conclusion: Periosteal osteosarcoma (PEO) is a surface osteosarcoma among with parosteal osteosarcoma and high-grade surface osteosarcoma. Periosteal osteosarcoma affect mostly diaphyseal of long bone, especially femur and tibia. Clavicle is the extremely rare position of periosteal osteosarcoma with only two cases documented in English literature. The radiologic characteristic of periosteal osteosarcoma is a soft-tissue mass that causes extrinsic erosion of thickened underlying bone cortex and periosteal reaction extending into the soft-tissue surrounding. Current treatment included neoadjuvant followed by wide tumor resection. Partial, sub-total or total clavilectomy is the treatment of choice in case of periosteal arising from clavicle. Total claviclectomy without reconstruction can achieved good oncological and functional outcome. Surgical treatment prognosis is good with good with 5 year survival rate >80 %.
Keywords: Clavicle; Claviculectomy; Periosteal sarcoma.