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Review
. 2025 Jan 29;23(1):31.
doi: 10.1186/s12957-025-03676-7.

Primary extraskeletal osteosarcoma of rectal mesentery: a rare case and literature review

Zhikui Huo  1 , Yao Sun  1 , Jinghui Chang  1 , Guo-Dong Li  1 , Jian Shi  1 , Cheng Quan  1 , Li-Na Zhang  1 , Ting-Ting Yang  1 , Feng-Jia Shang  1 , Yong-Ping Yang  2
Affiliations
Review

Primary extraskeletal osteosarcoma of rectal mesentery: a rare case and literature review

Zhikui Huo et al. World J Surg Oncol. .

Abstract

Background: Extraskeletal osteosarcoma (ESOS) is a rare kind of sarcoma with a low preoperative diagnosis and a poor prognosis. ESOS arising from abdominal mesentery is extremely rare. Increasing diagnostic methods and standardizing treatment protocols are crucial issues of ESOS.

Case presentation: We report the case of a 52-year-old female ESOS patient. She had a history of ovarian carcinoma (stage IIIC) surgery two years before, with five cycles of chemotherapy. A mass was found during postoperative examinations. A R0 surgical resection was performed. Post-operational pathological report plus intra-surgery findings supported a diagnosis of ESOS. She is still alive 10 months post-operationally, with routine blood and radiographical examinations.

Conclusion: Enhancing awareness of this extremely rare disease together with advancements in diagnostic methods will hopefully enable earlier recognition and initiation of treatment. Protocols for standardizing treatments require a larger multi-center collaboration and more data analysis.

Keywords: Extraskeletal osteosarcoma; Poor prognosis; Rectal mesentery; Surgical resection.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The authors certify that they obtained all appropriate patient consent forms. They were assured that the patient’s names and initials would not be published and due efforts would be made to conceal the identity of the patient, although anonymity could not be guaranteed. Consent for publication: We got the consent of the patient and family members before using the patient’s data in this study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
18F-FDG-PET-CT 5 and 8 months pre-surgery. (A. C-E) PET-CT 8 months pre-surgery, confirmed abnormal uptake inside the calcified mass. (ESOS with arrows) (B. F–H) PET-CT 5 months pre-surgery,after four cycles of chemotherapy and bevacizumab finished. The mass has shrunk significantly. (ESOS with arrows)
Fig. 2
Fig. 2
CT scan pre-surgery and 4 and 9 months post-surgery. (A) A homogeneous soft-tissuemass with internal calcifications or ossifications in rectal mesentery.(with a white arrow) (B) A CT scan 4 months post-surgery showed no local recurrence:(bowel lumen anastomosissite with white arrows) (C) A CT scan 9 months post-surgery showed no local recurrence.(bowel lumen anastomosis site with white arrows)
Fig. 3
Fig. 3
Morphological and immunohistochemical results post-surgery. (A) 6cm ×5cm × 4 cm mass located in the mesorectum, invading part of the rectal wall. (B) The tumor cellsdemonstrated atypical mitotic figures. (haematoxylin and eosin stain, original magnification×200) (C) Immunohistochemical staining revealed the tumor cells was approximately 40%positive for Ki67 (original magnification × 200). (D) Immunohistochemical staining revealedthe tumor cells was positive for SATB2 (original maqnification × 200)
Fig. 4
Fig. 4
Coloscopy 9 months post-surgery. (A-C) No recurrenceevidence found
Fig. 5
Fig. 5
PET-CT was performed 13 months after surgery. (A-D) Increased metabolic activity within the liver and adjacent descending colon nodes suggestive of malignant metastases. (Metastatic lesion with arrows)
See this image and copyright information in PMC

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