parosteal osteosarcoma metastasis

By biological explanation of schizophrenia tutor2u 25 June 2022

The suspicion of a recurrence of parosteal osteosarcoma, already metastatic, led to a second wide resection with no reconstruction. slow growing & late to metastasize. Case report A 33-year-old male presented with a three-month history of a painless enlarging lump on the right side of the maxilla in the premolar/molar region. Learn more about the subtypes, causes, symptoms, diagnosis, treatment, and prognosis for osteosarcoma. Parosteal Osteosarcoma is a slow-growing, rare bone tumor arising from the cortical surface of the bone. Osteosarcoma located in the chest and pelvic bones was associated with metastatic disease; however, metastasis in two histological types, parosteal and periosteal, was infrequent. The most common site for parosteal osteosarcoma is the posterior distal femur. The natural history of this disease may extend to five years or longer before metastasis occurs. Osteosarcoma is a kind of bone cancer which generally starts to develop in the lengthy bones in the legs and arms. Treatment options include wide excision and endoprosthetic or allograft. Pathology in practice. This was reported in autopsy cases, which found 90% of patients with osteosarcoma would have lung metastasis and 1012% with renal metastasis alone. Fewer than 50 cases of osteosarcoma involving the hand have been reported in the literature. Abstract Parosteal osteosarcoma is a rare malignancy of the bone that usually arises in the long bones. 7% (196/2898) 5. The natural history of this disease may extend to five years or longer before metastasis occurs. Metastasis mostly occurs with high-grade tumors disseminating to the lungs and other bones. CONCLUSION: The review leads to the conclusion that the occurrence of metastasis from parosteal osteosarcoma can occur in up to 38% of the cases, in spite of its relatively low aggressiveness. Metastasis. Marina NM, Pratt CB, Rao BN et al. Parosteal osteosarcoma is slow-growing and late to metastasize; accordingly, it carries a better prognosis than other variants of osteosarcoma. Tumors are either low grade (G1) or high grade (G2). Sites of Involvement. and one leading to distal metastasis . The manual recognition of osteosarcoma necessitates expert knowledge and is time consuming. 3, 4 These lesions frequently cause metastatic disease and death, and therefore these patients are usually managed with a combination of surgery and chemotherapy. It is a relatively rare disease entity, comprised only 4% of all osteosarcomas and barely reported in the literature. In contrast to osseous metaplasia, these lesions have foci reminiscent of parosteal osteosarcoma or low grade central osteosarcoma (Am J Surg Pathol 2010;34:1361) Pitfalls and tips : Nuclei with sharply outlined vacuoles (Lochkern cells) are enlarged and can appear hyperchromatic but are normal adipocytes cut in cross section The lung mass was found to be a metastasis from parosteal osteosarcoma and the biopsy of the forearm mass revealed a myositis ossificans. Correct diagnosis of parosteal osteosarcoma is challenging for an orthopedic surgeon. It also can form on the surface of bones in the arms called the ulna and the humerus. There was no evidence of local recurrence or distal metastasis after a 1-year follow-up. Statistical analysis of the thirty-nine patients who had had the primary treatment at our institution revealed that incomplete resection was associated with an increased risk of local recurrence and that dedifferentiation markedly increased the risk of metastasis. Work-up is negative for metastasis, but biopsy reveals a high grade lesion. Parosteal osteosarcoma can be treated successfully with wide excision of the primary tumor alone. Medullary involvement occurs in <25% of cases. A long diaphyseal segment of the femur containing the tumor was resected along with a Introduction. In reviews of parosteal OS, 1,2,5,6 the incidence of dedifferentiation is 16%. 1. However, due to the low local recurrence and metastasis rate, when it appears in the posterior surface of the distal femur, the lesion can be managed with hemicortical wide resection and biological reconstruction with hemicortical allograft. Osteosarcoma can spread from where it started to other areas, making treatment and recovery more difficult. DESCRIPTORS: Parosteal. 67% (1954/2898) 3. Parosteal osteosarcoma is a rare, low grade sarcoma. Introduction. There are numerous types of primary osteosarcoma, including intramedullary (high grade, telangiectatic, low grade, small cell, osteosarcomatosis, and gnathic), surface (intracortical, Additionally, it is uncharacteristic of the disease course of parosteal osteosarcoma to involve multiple local and pulmonary relapses. Medullary involvement occurs in <25% of cases. Taulescu MA, Carlson CS, Amorim IF, De Fatima Grtner M, Frca L, Gal AF, Ctoi C. J Am Vet Med Assoc, 245(10):1103-1105, 01 Nov 2014 The metastatic lesion was detected 8 years after the diagnosis of a parosteal type distal femur osteosarcoma that was confirmed on histopathological examination of the resected tumour. Metastasis mostly occurs with high-grade tumors disseminating to the lungs and other bones. We present a case o Parosteal osteosarcoma often develops at the posterior surface of the distal femur. curs in the third and fourth decades It usually forms on the surface of bones of the legs called the tibia and femur. [7,10] 22% (624/2898) 2. Osteosarcoma is the most common primary malignant tumor of bone in adolescents and young adults. In addition, the incidence rate of osteosarcoma was higher among male and female patients between the ages of 10 and 19. Osteosarcoma is a type of bone cancer that most often affects children and teens. 2,3 Although the exact 6.JacobsonSA.Earlyjuxtacortecal osteosarcoma (parosteal osteoma). Here we report the striking case of a 60-year-old patient who presented 16 years after the initial diagnosis of parosteal osteosarcoma of the humerus with a new extensive lung lesion. Osteosarcoma that spreads most often spreads to the lungs and to other bones. high grade tumors. Osteosarcoma is defined as the primary malignant mesenchymal bone tumor where the malignant tumor cells directly form the osteoid or bone or both. The most common location is the posterior distal femur. parosteal osteosarcoma, low grade I am assuming by now you have been through the procedures. Abstract. It most commonly occurs in young women over the metaphyseal region, especially the long bones near the knee joint. On the other hand, the treatment of low-grade central and parosteal osteosarcomas can rely on surgery alone, provided a complete assessment of their metastatic potential . Delayed recurrences (>5 years) of Osteosarcoma. Metastasis / Myeloma; Aneurysmal Bone Cyst; Chondroblastoma / Chondromyxoid Fibroma; osteosarcoma, Ewings of flat bones: 30 40: reticulum cell sarcoma (Primary histiocytic lymphoma), fibrosarcoma, parosteal osteosarcoma, malignant giant cell tumor, lymphoma: 40 + metastatic carcinoma, multiple myeloma, chondrosarcoma: Distant: The cancer has spread to distant parts of the body, such as to the lungs or to bones in other parts of the body. Grades metastasis varies from 6 to 32 months, ria1. Parosteal Osteosarcoma is a malignant, low-grade, osteosarcoma that occurs on the surface of the metaphysis of long bones. Parosteal osteosarcoma is a low-grade, malignant bone tumor that usually arises on the metaphyseal surface of long bones. The tumor originates from the outer fibrous layer of periosteum. 1. Most common sites are the posterior aspect of the distal femur, proximal tibia, and proximal humerus. Parosteal osteosarcoma is a low-grade tumor microscopically. Parosteal Osteosarcoma is a malignant, low-grade, osteosarcoma that occurs on the surface of the metaphysis of long bones. Parosteal osteosarcoma (PAOS) is a surface osteosarcoma. Along the spectrum, parosteal osteosarcoma occupies the well-differentiated end. The manual recognition of osteosarcoma necessitates expert knowledge and is time (This is different from a parosteal osteosarcoma which is a low grade, surface fibroblastic sarcoma that produces bone/osteoid, arises from the outer layer of the periosteum and therefore does not elevate the periosteum nor cause a periosteal reaction.) Parosteal osteosarcoma is a rare malignant bone tumor arising from the bone cortical surface. Parosteal osteosarcoma (PAOS) is a surface osteosarcoma. Parosteal osteosarcoma is a locally aggressive malignant tumor, and resection with a wide margin is the most appropriate treatment. The case of a 50-year-old man who presented with nontraumatic swelling of the left upper arm and there are no signs of tumor recurrence or metastasis and the proximal osteotomy has healed nicely; the distal fixation osteotomy exhibits delayed healing. The objective of this study is to describe cases of parosteal What is Parosteal Osteosarcoma? In the spring of 2020, we, the members of the editorial board of the American Journal of Surgery, committed to using our collective voices to publicly address and call for action against racism and social injustices in our society. Metastatic rate of 2847 % for dedifferentiated tumors. Parosteal Osteosarcoma. Intramedullary well-differentiated osteosarcoma. Samuels et al. A 12yearold Maltese terrier was evaluated for progressive tetraparesis and neck pain. A diagnosis of parosteal osteosarcoma (POS) at the femoral diaphysis was made following a diagnostic workup. Surgical resection with a It accounts for approximately 15% of all primary bone tumors confirmed at biopsy. The tumor occurs over the metaphyseal region, especially the long bones, near the knees. Parosteal Osteosarcoma. Descriptors: Parosteal. Mc site Posterior metaphysis of distal femur. The most common location is the posterior aspect of distal femur (thigh bone), in approximately 70% of the cases. synovial sarcoma, 39 Bizarre parosteal osteochondromatous proliferation (BPOP), 475, 479 Blood products PVNS differential diagnosis and, 184 VM, synovial with, 188. Has the tumour spread into surrounding tissues? Chondrosarcoma was determined in two patients and osteosarcoma in two, and amputation at an appropriate level was performed in these patients (Table 3). Approximately 80% of tumors are grade 1 and 20% are grade 2.2 Accordingly, it has a well differentiated spindle cell stroma, minimal atypia and a low mitotic rate. Metastatic Parosteal Osteosarcoma in a Dog elbow, thorax, and abdomen were performed under routine general anesthesia with Iohexol administration (2 mL/kg IV). I had the tumor on the femur above the knee 7 years ago. It is regarded as a distinct form of osteosarcoma with better prognosis than conventional osteosarcoma. Parosteal osteosarcoma occurs more often in older patients than does conventional high-grade osteosarcoma and is most common in patients aged 20 to 30 years. Co-amplification of CDK4, SAS and MDM2 in surface osteosarcoma. M alignant bone tumors are rarely seen in the hand. Background : Parosteal osteosarcoma is a rare, well-differentiated, predominantly fibro-osseous variant of osteosarcoma. Myocardial. The Editors of Clinical Imaging in conjunction with the Elsevier Office of Continuing Medical Education are pleased to offer an AMA PRA Category 1 CME credit program for registered Clinical Imaging physician reviewers who complete manuscript reviews. Parosteal Osteosarcoma. Patient expired 6 months later after a course of chemotherapy and radiation due to generalized metastatic disease and multiple organ failure. The highest incidence of POS oc- I and II are characterized as low grade, with an average of 16 months2. However, myocardial metastasis of a parosteal osteosarcoma is an event that was not found in the literature. A slice of the radial cortex was taken Surgical removal of lung metastases from a primary osteosarcoma is a standard of care when there is a small number of lung nodules that can be removed safely, and can be associated with a 30-35% cure rate. Cancer that spreads (metastasizes). What is the stage of this tumor by the Musculoskeletal Tumor Society system? They must be included in any differential diagnosis of a spinal bone lesion in a patient older than 40 years. Partial osteosarcoma is a slowly growing subtype of bone-forming cancer that arises from the outer layer of the periosteum. Partial osteosarcoma is a slowly growing subtype of bone-forming cancer that arises from the outer layer of the periosteum. In only 15% of cases, it can spread to the [] Symptomatic renal metastasis is very rare in osteosarcoma. It accounts for about 4% of all osteosarcomas and, although rare, it is the most common type of osteosarcoma of the bone surface .Approximately 8% to 25% of the cases reported in literature developed dedifferentiation, Background: Parosteal osteosarcoma is a rare, well-differentiated, predominantly fibro-osseous variant of osteosarcoma. Productive osteoblastic osteosarcoma of the left humerus with unilateral eye, cervical muscle, pulmonary, renal, jejunal mesentery, and liver metastases. Treatment. The vast majority involve the metaphysis of the femur, humerus, or tibia. - about 10% of parosteal tumors exhibit areas of dedifferentiation into high grade sarcoma & are thus considered stage IIb lesions. Parosteal osteosarcoma (PAOS) is a low-grade osteosarcoma that originates from the periosteum. Osteosarcoma is the most common primary malignant bone tumor in childhood and the second most common primary malignancy of bone in adults (after multiple myeloma). 2% (44/2898) 4. CONCLUSION:The review leads to the conclusion that the occurrence of metastasis from parosteal osteosarcoma can occur in up to 38% of the cases, in spite of its relatively low aggressiveness. [7,10] of diagnosis or at the time of recurrence [3]. Copeland, parosteal osteosarcoma is a slow-growing malignant tumor arising on the surface of the metaphysis of long bones, representing 5% of all primary osteo - Histopathologic diagnosis was parosteal osteosarcoma of the vertebra. It is regarded as a distinct form of osteosarcoma with better prognosis than conventional osteosarcoma. 5-year relative survival rates for osteosarcoma Metastases to the lung in parosteal osteosarcoma occur both later and with considerably less frequency compared with metastases in conventional osteosarcoma [1, 2]. A system commonly used to stage osteosarcoma is the MSTS system, also known as the Enneking system. Because of an increase in occurrence of cancer and patient-specific treatment options, the detection and classification of cancer becomes a difficult process. Parosteal osteosarcoma is a sarcoma that has it's origin on the surface of the bone. Osteosarcoma occurring as a primary tumour in the rib is rare and there are only a few case reports existing in the literature as a primary parosteal osteosarcoma of the ribs [2, 3]. e.g. Taulescu MA, Carlson CS, Amorim IF, De Fatima Grtner M, Frca L, Gal AF, Ctoi C. J Am Vet Med Assoc, 245(10):1103-1105, 01 Nov 2014 This never bothered me. However, low-grade scintigraphic activity has sometimes been reported in histologically proven enostoses, particularly if the lesion is >1 cm 3. How common is PO? However, myocardial metastasis of a parosteal osteosarcoma is an event that was not found in the literature. Its relatively benign course was described by Mller as early as 1843 (13), but it was not before 1947 that parosteal osteoid sarcoma, representing only 1 per 1,2,3,4,5,6,7,8,9,10,11,12 Demonstration of osteoid directly formed by the malignant cells in histopathology is essential for making the diagnosis of osteosarcoma. It is based on 3 key pieces of information: The grade (G) of the tumor, which is a measure of how likely it is to grow and spread, based on how it looks under the microscope. It arises on the surface of the bone and invades the medullary cavity only at a late stage. The prognosis for parosteal osteosarcoma is better than that for conventional osteosarcoma, as the 5-year overall survival rate is 86%-91% for the former but 53%-61% for the latter. This article will focus only on the metastasis involving the bony structures of the spine; please refer to the specific articles for Microscopically, it is composed of a low grade fibrous stroma and less mitoses and cellular atypia when compared with conventional osteosarcoma (Okada 1994). Parosteal osteosarcoma . J BoneJointSurg(Am]1958:40:1310-1328 7.Scaglietti 0.Calandriello B.Ossifying parosteal sarcoma. 22 The lung mass was found to be a metastasis from parosteal osteosarcoma and the biopsy of the forearm mass revealed a The vast majority involve the metaphysis of the femur, humerus, or tibia. Osteosarcoma occurring as a primary tumour in the rib is rare and there are only a few case reports existing in the literature as a primary parosteal osteosarcoma of the ribs [2, 3]. Fig. Large ossified mass in centre. Parosteal osteoid sarcoma, sometimes referred to asjuxtacortical osteogenic sarcoma, is a rare malignant bone tumor which must be differentiated from an osteosarcoma clinically, roentgenologically, and histologically. Metastatic carcinoma : As is obvious, the presence of multiple radiographically evident bony lesions should be investigated to rule out the more likely possibility of metastatic disease to the skeleton, rather than the rare multifocal osteosarcoma. Parosteal osteosarcoma occurs more often in older patients than does conventional high-grade osteosarcoma and is most common in patients aged 20 to 30 years. Treatment and prognosis Productive osteoblastic osteosarcoma of the left humerus with unilateral eye, cervical muscle, pulmonary, renal, jejunal mesentery, and liver metastases. 1 Among the primary osteosarcomas, the parosteal variant is extremely rare and there are only 6 dedifferentiated high grade Parosteal osteosarcoma was rendered. Heart. High and heterogeneous signal on T2-weighted images of Grade I, II, and III tumors is not specific for the dedifferentiation of parosteal osteosarcoma component, due to hemorrhage and necrosis in large masses, therefore, high signal intensity on T1- Weighted images is not always a reliable way to predict the grade of the tumor. Heart. Parosteal Osteosarcoma Periosteal Osteosarcoma Telangiectatic Osteosarcoma Well-differentiated liposarcomas exhibit < 10% local recurrence rates and <1% chance of metastasis and almost complete survival. PO is most common in young people between the ages of 15 and 30 years old. It grows primarily into the surrounding soft tissues, but Parosteal osteosarcoma is a low-grade, malignant bone tumor that usually arises on the metaphyseal surface of long bones. Periosteal osteosarcoma, or PO, is a rare type of bone cancer. There was no evidence of local recurrence or distal metastasis after a 1-year follow-up. Patient expired 6 months later after a course of chemotherapy and radiation due to generalized metastatic disease and multiple organ failure. (p=0.017, p=0.002,p=0.005) The most common resection type was segmental articular resection (9 patients). Background . We report a rare case of dedifferentiated parosteal osteosarcoma (dd-POS) with well-differentiated multiple metastases in a 65-year-old woman with a painful firm mass on her thigh. Patient was not a surgical candidate due to extensive metastatic disease, and difficult to access sites of metastasis. Patient was not a surgical candidate due to extensive metastatic disease, and difficult to access sites of metastasis. Parosteal Osteosarcoma of the Distal Femur Olga D Savvidou ,1,2 Stavros Goumenos,1,2 Ioannis Trikoupis,1,2 Angelos Kaspiris ,3 Dimitra Melissaridou,1,2 Panagiotis Gavriil,1,2 Jimmy Georgoulis,1,2 and Panayiotis J Papagelopoulos 1,2 1First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, Zografou, Greece Periosteal osteosarcoma is also capable of local recurrence and distant metastasis. Systemic metastasis is rare overall and occurs in 10-15% of patients only. e.g. The periosteum is a thin layer that covers the outer surface of the bone and provides structural integrity and produces bone-forming cells. Spread to the pancreas is extremely rare and is undocumented in the low-grade histologic subtype of parosteal osteosarcoma. The pathogenesis of parosteal osteosarcoma is discussed. Treatment options include wide excision and endoprosthetic or allograft. It is slow growing and slow to metastasize. Because parosteal osteosarcoma can dedifferentiate and metastasize and can cause local infiltration and destruction, its presence is an indication Synovial Sarcoma. As parosteal osteosarcomas tend to be low-grade lesions, they are usually treated with surgical resection, without chemotherapy or radiation. On radiographs, there was a periosteal reaction involving the fourth cervical vertebra. The most common location is the posterior distal femur. This may be either at the time amputation. Dedifferentiated parosteal osteosarcoma and high-grade surface osteosarcoma, the third and fourth types, are very rare and highly malignant tumors, associated with a poor prognosis. AMA PRA Category 1 CME credit for Clinical Imaging reviewers. The patient developed lung metastasis and a mass in the interosseus membrane of the forearm proximally to the osteotomy. Osteosarcoma. Osteosarcoma is the most common primary malignant tumor of bone in adolescents and young adults. PAOS represents 46% of OS and commonly affects the posterior aspect of the distal femur. Parosteal osteosarcoma represents a low-grade, well-differentiated type of cortical surface osteosarcoma with a relatively better prognosis. Sites of Involvement. Regional: The cancer has spread outside the bone and into nearby structures, or it has reached nearby lymph nodes. Vertebral metastases represent the secondary involvement of the vertebral spine by hematogenously-disseminated metastatic cells. Please rate this review topic. Outcomes of dogs with POSA treated with radiation therapy may Patients typically present between ages 30 and 40 with a painfless mass. greater metastastatic potential. What is Parosteal Osteosarcoma? Hence, these are malignant bone tumors. Using comparative genomic hybridization (CGH) and fluorescent in situ hybridization (FISH), we were able to confirm a late relapse of the initial osteosarcoma. However, it rarely manifests as a dedifferentiated fashion, which is usually more abrupt and is associated with poorer prognosis. Parosteal Osteosarcoma. Dedifferentiated chondrosarcoma. Parosteal OS is a low-grade sarcoma of the bone surface in which hypocellular spindle-cell stroma forms well-differentiated osseous trabeculae. Dedifferentiation into telangiectatic osteosarcoma described with fluid-fluid levels on MR imaging. The EOCME is accredited by the 7A Lytic metastasis in invasive ductal carcinoma of the breast in such as osteosarcoma. Parosteal osteosarcoma is a low grade surface variant. Skip metastasis, conventional osteosarcoma demonstrating, 120 Slipped capital femoral epiphysis (SCFE), 421427 additional examples, 425437 Most common type of juxtacortical/surface osteosarcoma I have no complaints other than a typical 2 hour wait in the office for folo up appointments. Parosteal osteosarcoma is a low grade, well differentiated fibroblastic tumor that produces bone/osteoid (immature woven bone). Parosteal osteosarcoma. Using comparative genomic hybridization (CGH) and fluorescent in situ hybridization (FISH), we were able to confirm a late relapse of the initial osteosarcoma. Treatment. Forty-one cases of parosteal osteosarcoma were reviewed clinically, radiologically and pathologically. Patients typically present between ages 30 and 40 with a painfless mass. - parosteal osteosarcoma is distinguished from classic osteosarcoma by its much slower, less aggressive clinical course. You have never rated this topic. The malignant bone tumor most determined was Ewing's sarcoma in 10 patients, of which two had lung metastasis and one had metastasis in the shoulder and acetabulum. Surgery that removes the tumor and spares the limb is used whenever possible. Osteochondroma. We report the case of a parosteal osteosarcoma of the distal ulna, treated with wide resection without reconstruction. It arises from the surface of the bone, namely the outer layer of the periosteum. No metastases were seen from Grade I tumours despite a number of local recurrences. The neurovascular involvement was related with metastatic disease, deep infections and complication related surgeries. 2% In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. However, myocardial metastasis of a parosteal osteosarcoma is an event that was not found in the literature. Parosteal Os-teoma orjuxtacortical osteogenic sarcoma. Previous reports of long bone diaphyseal POS are rare. However, myocardial metastasis of a parosteal osteosarcoma is an event that was not found in the literature. Involvement of the oral cavity is rare. In only 15% of cases, it can spread to the [] Pathology in practice. In the present paper, we report a case of parosteal osteosarcoma involving the maxilla. It accounts for approximately 15% of all primary bone tumors confirmed at biopsy. PURPOSE To assess the role of magnetic There is usually no technetium-99m MDP uptake, and a normal bone scan can exclude an osteoblastic metastasis or osteosarcoma. Correct diagnosis of parosteal osteosarcoma is challenging for an orthopedic surgeon. Osteosarcoma ppt 1. The present report describes a case of a 44-year-old female patient who presented with a palpable mass of the left thigh. Irrespective of the treatment plan, whether monomodal or multimodal, the principles of surgery remain just the same. osteosarcoma is regarded as low grade and tends to have the best prognosis after wide resection and has minimal metastatic potential. Here we report the striking case of a 60-year-old patient who presented 16 years after the initial diagnosis of parosteal osteosarcoma of the humerus with a new extensive lung lesion. We focus on parosteal OS and dedifferentiated parosteal OS. Adapting to limb amputation. Parosteal osteosarcoma, a subclass of low-grade OS, has a fibroblastic-like appearance and is limited to the surface of bone structures; however, it may gradually spread to interior bone tissues. Parosteal osteosarcoma can be treated successfully with wide excision of the primary tumor alone. The differential diagnosis mostly depends on the review of Mostly occurs at the age of 30-40 years old. 1 Most are secondary osteosarcomas occurring after prior radiation therapy, pagetoid osteosarcomas, or metastases. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. As they are frequently metaphyseal in location, large parosteal osteosarcomas or those with deep medullary invasion may require limb salvage, including joint replacement. Dr. Healey performed the surgery at MSK. Aim: We report an unusual case of abdominal mass recurrence of parosteal osteosarcoma of the left distal femur treated eight years JBoneJointSurg(Am] 1962:44:635-647 8.DahlinDC.Parosteal osteogenic sarcoma (juxtacortical osteogenic sar- Osteo = bone/osteoid tissue Sarcoma = malignant tumor of connective tissue 04/28/14 1 Parosteal OS Arise from the periosteum. Metastatic rate of 2847 % for dedifferentiated tumors. Among these tumors, the osteosarcoma is the commonest primary malignant tumor, comprising of approximately 35% of all bone malignant tumors, followed by others like chondrosarcoma (25%), Ewing sarcoma (EWS) (16%), and chordomas (8%). 1. It accounts for about 4% of all osteosarcomas and, although rare, it is the most common type of osteosarcoma of the bone surface .Approximately 8% to 25% of the cases reported in literature developed dedifferentiation, CONCLUSION:The review leads to the conclusion that the occurrence of metastasis from parosteal osteosarcoma can occur in up to 38% of the cases, in spite of its relatively low aggressiveness. Additionally, it is uncharacteristic of the disease course of parosteal osteosarcoma to involve multiple local and pulmonary relapses. Osteosarcoma arising from cortical surface is classified into parosteal, periosteal and high-grade surface osteosarcoma. Women > Men. The most common site for parosteal osteosarcoma is the posterior distal femur. Vertebral tumors may be primary or metastatic. A few reported cases had pulmonary metastases before renal involvement. Periosteal osteosarcoma. Primary neoplasm of the bones is relatively uncommon.