Cytokeratin — positive rib osteosarcoma metastasizing to the small intestine.
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Date
2014-01
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Abstract
Osteosarcoma (OS) is a malignant tumor in which osteoid or bone is produced
directly by tumor cells. Some OS cells are positive for cytokeratin (CK) and
epithelial membrane antigen by immunohistochemistry (IHC) and this may lead
to a misdiagnosis of metastatic carcinoma, particularly when the tumor location is
unusual. On the other hand, gastrointestinal metastasis of OS is rare. We present
the case of a 67-year-old Japanese man with a small intestinal intussusception
due to metastasis of a CK-positive rib OS. The tumor cells were positive for
CK, osteopontin and osteonectin by IHC and a diagnosis of a CK-positive
chest wall OS metastasizing to the small intestine was considered. Osteoid
or bone formation was histologically absent and therefore chest wall OS had
to be differentially diagnosed from metastatic carcinoma of unknown origin. A
postmortem histological analysis confi rmed a rib OS. Awareness of CK-positive
OS is important for making a correct diagnosis and for disease management and
an immunohistochemical analysis of the tumor for expression of osteopontin and
osteonectin may be used to support the diagnosis. In addition, this case shows
that rib OS can metastasize to the gastrointestinal tract, albeit rarely, which may
induce an intestinal intussusception.
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Keywords
Cytokeratin, intussusception, osteonectin, osteosarcoma, osteopontin, small intestinal
Citation
Kuwabara Hiroko, Fujita Kazuhiko, Yuki Masako, Goto Isao, Hanafusa Toshiaki, Shibayama Yuro. Cytokeratin — positive rib osteosarcoma metastasizing to the small intestine. Indian Journal of Pathology & Microbiology. 2014 Jan-Mar 57 (1): 109-113.