Osteosarcoma is one of the common types of bone cancer. Though Osteosarcoma can develop in any part of the body, the most common sites are around the knee joint and close to the shoulder. As it develops from osteoblasts (the cells of developing bone), it commonly occurs in children. It is probably caused by genetic factors which changes immature bone cells into cancer cells.

Clinical Presentation:
1. pain and swelling in leg or arm
2. limping gait
3. fracture with trivial trauma
4. backache
5. loss of bladder/ bowel control ( pelvic osteosarcoma)

1. swelling just above or below knee joint/ upper arm/ near shoulder
2. painful & limited movements of joint
3. limping gait in case of leg swelling
4. signs of incontinence of bladder/ bowel in case of pelvic or spinal osteosarcoma
5. chest signs in case of metastatic or advanced disease

1. X-ray of bone- Lytic lesion with indistinct margins or ossification in the soft tissue with sunburst pattern. Reactive new bone formation is seen as a periosteal elevation, a sign named as a ‘Codman’s angle’ or ‘Codman’s triangle’.
2. MRI of involved bone
3. CT chest
4. Bone scan
5. Tru-cut needle biopsy of tumor

1. Central Osteosarcoma
Small cell
Low grade
2. Surface Osteosarcoma
High grade

1. Surgical: Surgical treatments for osteosarcoma consist of either amputation or limb-salvage surgery. Nowadays Limb salvage surgery preferred over amputation. In case of metastatic disease in the lungs, surgery is done to do pulmonary metastatecomy.
2. Chemotherapy: Chemotherapy is given before as well as after surgery. This is called Neoadjuvant chemotherapy and Adjuvant chemotherapy. It removes the microscopic disease in the body.
3. Radiotherapy: The use of radiotherapy is limited in osteosarcoma as it is not very effective. It is used in osteosarcoma that can not be removed surgically.

In localized disease 60 to 80% survival rate has been reported. Limb osteosarcoma has better prognosis than flat bone osteosarcoma.

Ovarian Carcinomas in Pediatric Age Group

Ovarian Carcinomas are unusual in pediatric age group. It accounts for only 1% of all tumors in girls below the age of 17 years. In the first differential diagnosis of ovarian tumors in adolescent girls, germ cell tumor comes first and carcinomas comes last.

Clinical Presentation:
Abdominal distension
Lower abdominal pain
Weight loss

Grossly underweight
Lower abdominal mass

Tumor markers
- CA 125
CA 125 - CA 125 serology has only 78.1 % sensitivity & 76.8 % specificity but it is useful in identifying recurrent or residual disease.
Ultrasonography- solid, cystic or mixed; arising from, areas of hemorrhage, liver metastasis, retroperitoneal lymph nodes.
CT scan- extent of tumor, exact origin of tumor, better delineation, lymph node status, peritoneal metastasis
Bone scan-for detection of metastasis.


is done to confirm the diagnosis, stage the disease, & achieve tumor clearance in early stages & cytoreduction in late cases.
Chemotherapy: Cisplatin, cyclophosphamide, carboplatin, bleomycin, etoposide, & paclitaxel in various combinations.

Stage of the disease

However the prognosis in premenarchal girls appears to be poor with no reported long term survivors.