Primary osteosarcoma of the scapula in an adolescent: a case report and review of the literature
Ibrahim Aljnide, Nawwar Shaheen, Rand A. Eid, Yasser IskandarBackground:
Osteosarcoma is the most common primary malignant bone tumor, yet its occurrence in the scapula is exceptionally rare. The complex anatomy of the shoulder girdle and nonspecific presenting symptoms often lead to diagnostic delays.
Case presentation:
A 16-year-old male with no significant past medical history presented with several months of progressive swelling and pain in the right scapular region. Magnetic resonance imaging revealed a large, heterogeneous mass arising from the scapula with an extensive soft-tissue component. Core needle biopsy confirmed high-grade conventional osteoblastic osteosarcoma (Enneking stage IIB, AJCC stage IIB). Staging investigations, including chest computed tomography and a bone scan, revealed no evidence of metastatic disease. The patient received neoadjuvant chemotherapy following the Methotrexate, Adriamycin (doxorubicin), and Platinol (cisplatin) protocol (high-dose methotrexate, doxorubicin, and cisplatin). A subsequent radical en bloc total scapulectomy achieved negative margins (R0 resection). Postoperative histopathology demonstrated greater than 90% tumor necrosis (Huvos grade IV). No bony reconstruction was performed; a flail shoulder was accepted to avoid implant-related complications.
Discussion:
At 18 months postoperatively, the patient remains disease-free, with no evidence of local recurrence or metastasis. Functional assessment using the Musculoskeletal Tumor Society score yielded 63%, and the Toronto Extremity Salvage Score was 68%. The patient has completed all adjuvant chemotherapy cycles without significant complications.
Conclusion:
This case demonstrates that multidisciplinary management – neoadjuvant chemotherapy followed by radical resection with negative margins – can achieve favorable local control. While total scapulectomy sacrifices shoulder abduction, it preserves hand and elbow function, offering a viable limb-sparing option. The rarity of this tumor underscores the importance of continued case reporting to refine diagnostic and therapeutic approaches.