Fatal embolic chondroblastic osteosarcoma to the lung is an extremely rare phenomenon. We report a case of a 15-year-old boy who developed bilateral pulmonary embolism shortly after resection of the right distal femur for chondroblastic osteosarcoma. The patient succumbed to right-sided heart failure 8 weeks later. An autopsy revealed extensive intravascular tumor emboli in the bilateral pulmonary arteries and their branches. No metastatic lesions were identified in the lungs. We review the clinical, radiologic, and pathologic findings of this patient and the literature.
BillingsleyKGBurtMEJaraE. Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and post-metastasis survival. Ann Surg1999;229:602–612.
2.
LaurainAR. Intracardial tumor culture of osteogenic sarcoma with fatal tumor embolism; report of a case. Am J Clin Pathol1957;27:664–671.
3.
BoothAJTweedCS. Fatal pulmonary embolism due to osteogenic sarcoma in a child. Clin Radiol1989;40:533–535.
4.
WakasaKSakuraiMUchidaAYoshikawaHMaedaA. Massive pulmonary tumor emboli in osteosarcoma. Occult and fatal complication. Cancer1990;66:583–586.
5.
WongPSAyeWMLeeCN. Pulmonary tumor embolism secondary to osteosarcoma. Ann Thorac Surg2004;77:341.
6.
AhmedAAHellerDS. Fatal pulmonary tumor embolism caused by chondroblastic osteosarcoma: report of a case and review of the literature. Arch Pathol Lab Med1999;123:437–440.
7.
NewkirkLVaterYOxornDMulliganMConradE. Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection. Can J Anaesth2003;50:886–890.
KaneRDHawkinsHKMillerJANocePS. Microscopic pulmonary tumor emboli associated with dyspnea. Cancer1975;36:1473–1482.
10.
VeinotJPFordSEPriceRG. Subacute cor pulmonale due to tumor embolization. Arch Pathol Lab Med1992;116:131–134.
11.
GoldhaberSZDrickerEBuringJE. Clinical suspicion of autopsy-proven thrombotic and tumor pulmonary embolism in cancer patients. Am Heart J1987;114:1432–1435.
12.
MorrellMTDunnillMS. The post-mortem incidence of pulmonary embolism in a hospital population. Br J Surg1968;55:347–352.
13.
ShepardJAMooreEHTempletonPAMcLoudTC. Pulmonary intravascular tumor emboli: dilated and beaded peripheral pulmonary arteries at CT. Radiology1993;187:797–801.
14.
TingPTBurrowesPWGrayRR. Intravascular pulmonary metastases from sarcoma: appearance on computed tomography in 3 cases. Chest Radiol2005;56:214–218.
15.
HoefnagelCAMarcuseHRSomersR. Pulmonary tumor-embolism from intravascular osteosarcoma demonstrated by bone scintigraphy. Clin Nucl Med1982;7:574–576.
16.
SoaresFALandellGAde OliveiraJA. Subacute cor pulmonale in children: report of two cases. Pediatr Pulmonol1992;12:52–57.
17.
KrugerASanchez-SweatmanOHMartinDC. Host TIMP-1 overexpression confers resistance to experimental brain metastasis of a fibrosarcoma cell line. Oncogene1998;16:2419–2423.
