Diagnostic challenges and therapeutic approaches in pediatric osteosarcoma: A case report

Osteosarcoma (OS) is the most common primary malignant bone tumor. Radiological features may resemble benign processes, making diagnosis challenging. Delayed recognition can affect treatment outcomes, as timely intervention is crucial for managing the tumor effectively.

This report discusses the case of a 9-year-old girl who presented with left knee pain, without signs of fever or inflammation. Radiological imaging revealed a large, multilocular osteolytic lesion in the distal femur with sclerotic margins and no periosteal reaction, initially suggesting subacute osteomyelitis. A biopsy confirmed the diagnosis of OS. Staging studies revealed no distant metastases. The patient underwent neoadjuvant chemotherapy followed by a two-stage surgical procedure using the induced membrane technique for bone reconstruction. Histological examination of the resected tumor showed a high-grade osteoblastic OS with a good response to chemotherapy. After adjuvant chemotherapy, the patient achieved complete remission. One year postoperatively, a non-vascularized autograft was performed using fibula and iliac grafts.

The induced membrane technique proved successful, with good functional results and no complications. This case highlights the diagnostic challenges of osteosarcoma, particularly when the radiological features resemble benign conditions. Early diagnosis and a multidisciplinary approach, including surgery and chemotherapy, are essential for improving patient outcomes. Follow-up is critical to detect late complications in OS survivors.

Pediatric osteosarcoma presents significant diagnostic and therapeutic challenges. Early detection and a combination of surgery and chemotherapy are key to improving outcomes.