A 17-year-old-male stubbed his toe on his dresser. He stubbed his 2nd Metatarsal. The 2nd metatarsal became very swollen and tender to the touch. The patient believed that it was just a stubbed toe. Due to the extended period of time of the pain and swelling, he decided to go in to see the doctor. The injury was diagnosed as a broken toe, then a bone cyst and finally correctly diagnosed as osteosarcoma. The reason that this case is unique is because osteosarcoma tumor was missed twice during diagnosis.
In addition, bone pain is more often related to a benign condition, like an injury, rather than it is to cancer. Another unique aspect of this case is that Osteosarcoma in the “feet are rare, and seemingly theses cases differ in the presentation and behavior compared to those in usual locations. ”3 The diagnoses of “Osteosarcoma is the second most frequent malignant primary bone tumor. ”1 When doing my research I was thoroughly shocked. I thought that I had found a very unique case. After digging deeper into osteosarcoma it became very clear that this case was a rare as I hypothesized.
The research shows that “Osteosarcomas involving the bones of the foot are infrequent. ”1 Infrequent, what does that actually mean? The facts that were found “On the basis of the few series published, Osteosarcomas of the foot constitute only 0. 17%-2. 08% of all osteosarcomas, with a mean of 0. 83%. ”1 It is true that osteosarcoma is the second most common malignant bone tumor, which makes theses numbers even more staggering to look at. Osteosarcoma has millions of cases and fewer than 2% of those are found in foot.
Based on reviews of several large series of osteosarcoma Wu reported, “An average frequency of primary involvement the foot of 0. 83%. ”2While his partner Sneppen et al reported, “a frequency of primary osteosarcoma of the metatarsal bone of . 046%. ”2 “Osteosarcoma of the short tubular bones is rare. ”2 Osteosarcoma has been more commonly found in older populations; “the mean age at diagnosis of osteosarcoma is 33 years old”2 Due to this higher average in age there is not a higher finding of osteosarcoma in athletes. Osteosarcoma can be difficult at times to diagnose.
Especially when it occurs in rare/unique areas of the body. For example the “Initial misdiagnoses of osteosarcoma of the foot are not unusual”2 There are not many cases where osteosarcoma is found in the foot. For that exact reason, “the mean interval between the onset of symptoms and diagnosis of osteosarcoma of the foot is more than 2 years. ”2 Due to the age of the patient in my case. The doctors felt the delayed diagnose “was in part due to the fact that osteosarcoma in this location is generally seen in older patients and the diagnosis is not considered. 2
When comparing the diagnose time of regular osteosarcoma it is clear to see the rarity of the foot. The normal “average duration of symptoms was 13 months before a diagnosis of osteosarcoma. ” The key two symptoms of osteosarcoma are swelling and pain. In the studies review “All patients complained of pain, either with or without swelling. ”3 The only really differences between my case and the literature is that; “most of the previously reported patients presented with nonspecific pain and swelling. ”2 There are a few different ways that osteosarcoma can be treated.
The most common treatments are chemotherapy, amputation and radiation therapy. The patient in my study received both chemotherapy and amputation. This is the most common way to treat osteosarcoma for these two reasons. The amputation completely removes the most greatly infected area. This will drastically decrease the amount of time and where the malignant area can spread. Then the chemotherapy destroys the remaining cancerous cells. The outcome of this case was that the patient had an amputation of 2nd metatarsal along with chemotherapy.
This is one of the most common results that can occur with osteosarcoma. The patient was lucky enough to not have the cancer spread. In many cases when osteosarcoma is found in a unique place by the time it is diagnosed it has spread elsewhere. There are a lot of common themes that can be found that relates and a lot that differentiates. One of the biggest similarities is the misdiagnosis. According to the literature it would seem that there are not many cases where they diagnosis osteosarcoma correctly on the first try. As mentioned before, this is because of the rarity of the location of the osteosarcoma.
Another large similarity would be the treatment used. Amputation and chemotherapy is the most affect treatment available for osteosarcoma currently. Even though there are many similarities this case study is still extremely unique. The reason that there are so many similarities is because osteosarcoma is very common just not within in the feet. The biggest difference is the mechanism of injury. There are not many cases where a patient has been referred to a specialist from an acute injury. In this case study the patient went to see a specialist because he thought this toe was broken.
