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. 2018 Aug:105:49-55.
doi: 10.1016/j.ejrad.2018.05.021. Epub 2018 May 21.

Tumor thrombus in the large veins draining primary pelvic osteosarcoma on cross sectional imaging

Sireesha Yedururi  1 , Sumedha Chawla  2 , Behrang Amini  3 , Wei Wei  4 , Usama I Salem  5 , Ajaykumar C Morani  6 , Wei-Lien Wang  7 , Richard Gorlick  8 , Valerae O Lewis  9 , Najat C Daw  10
Affiliations

Tumor thrombus in the large veins draining primary pelvic osteosarcoma on cross sectional imaging

Sireesha Yedururi et al. Eur J Radiol. 2018 Aug.

Abstract

Purpose: To evaluate the frequency of tumor thrombus in the large veins draining primary pelvic osteosarcoma on early cross-sectional imaging studies and its effect on patient survival.

Materials and methods: Our retrospective study included all patients with primary pelvic osteosarcoma treated at our facility between January 2000 and May 2014, who were ≤ 45 years of age, and had adequate imaging studies and clinical follow up. Four radiologists evaluated for tumor in the large draining veins on initial CT, MRI and PET/CTs. A consensus evaluation by the four radiologists together with findings on operative reports, pathology reports or follow-up imaging was used as the reference standard.

Results: Thirty-nine patients with primary pelvic osteosarcoma met final inclusion criteria. Tumor thrombus was identified in the large draining veins in 10 of the 22 (45%) patients who underwent tumor resection and 10 of the 17 (59%) who did not. In the 22 patients who underwent tumor resection, tumor thrombus was significantly associated with worse overall survival (p = 0.03).

Conclusions: Tumor thrombus in the large draining veins is identified in a significant proportion of initial imaging studies in patients with pelvic osteosarcoma, and is associated with worse overall survival in patients who undergo tumor resection.

Keywords: Large draining veins; Pelvic osteosarcoma; Tumor thrombus.

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Figures

Fig. 1
Fig. 1
Of the 132 patients, 88 patients were initially excluded; incomplete imaging studies was the major reason for excluding patients (49%). Forty-four patients were selected for the initial imaging analysis. Five additional patients with tumor in the vein on imaging studies were excluded because of the lack of confirmation of tumor in vein by operative findings, pathology reports or follow-up imaging.
Fig. 2
Fig. 2
14-year old girl with left pelvic osteosarcoma. Axial T2 (A) and post-contrast T1-weighted (B) MRI illustrates left pelvic osteosarcoma (arrowhead) and tumor thrombus within the left common iliac vein (arrow). The primary tumor (arrowhead) and the venous tumor thrombus (arrow) were FDG avid on baseline axial fused PET/CT (C) confirming the malignant nature of the thrombus. Follow-up non contrast CT 4 months later (D) shows faint mineralization of the tumor thrombus within the persistently dilated left common iliac vein (arrow) similar to matrix mineralization within the primary tumor (arrow head) also confirming the malignant nature of the thrombus.
Fig. 3
Fig. 3
34-year old man with right pelvic osteosarcoma. Axial T2 (A) and post-contrast T1-weighted (B) MRI illustrates right pelvic osteosarcoma (arrowhead) and tumor within the right internal iliac vein (arrow). This patient underwent surgical resection of the tumor and the tumor thrombus in the large draining veins is confirmed by surgical pathology.
Fig. 4
Fig. 4
Overall survival curves of patients who underwent surgical resection of tumor without (no) and with (yes) tumor thrombus in the large draining veins. P-value by log-rank test. E = number of deaths, N = total number of patients.
See this image and copyright information in PMC

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