Recurrent tibial intra-cortical osteosarcoma: a case report and review of the literature

We present the case of a 21-year-old Thai woman who was thought to have an intra-cortical osteosarcoma of the right tibia. We performed a wide resection and reconstruction with bone transportation using an Ilizarov external fixator. The tumor recurred five years later at the same site with a similar histology. We performed a new resection and reconstruction by ankle arthrodesis with adjuvant chemotherapy. At the last follow-up, she had remained active and free from disease for seven years.This case report of recurrent intra-cortical osteosarcoma describes an atypical presentation. The low-grade histology, adequate surgical margin and adjuvant chemotherapy of the recurrent lesion were favorable factors, and our patient has remained free of any tumor recurrence.Intra-cortical osteosarcoma is a low-grade malignancy tumor of the cortical bone which typically does not extend into the intra-medullary and surrounding soft tissues. Only 18 cases have been reported in the literature, and the most common sites are the tibia (nine cases) and the femur (nine cases). The sex ratio of females to males is 5:13, and the median age is 19 years (range, nine to 43 years). Most cases present with slow progression, and treatment results in good oncological control. However, three cases have been reported in which the patient presented with distant metastasis [1,2]. Two had local recurrences with good oncological control after en bloc resection [3,4]. We describe the case of a woman whose tumor was compatible with an intra-cortical osteosarcoma with a one-time recurrence. The 12-year follow-up period of this patient provides additional valuable information regarding this variant of osteosarcoma.A 21-year-old Thai woman was evaluated for a lesion in her right tibial diaphysis. The mass exhibited slow, progressive enlargement over a one-year period, and she experienced occasional pain. Her physical examination revealed a hard-consistency mass at the anteromedial aspect of the right tibia a