Chondroblastic osteosarcoma of the rib as a second primary malignancy following neuroblastoma: a case report.
5 affiliations
- 1Department of General Surgery, MCM Comprehensive Specialized Hospital, Addis Ababa, Addis Ababa, Ethiopia. [email protected].
- 2Myungsung Medical College, Addis Ababa, Ethiopia. [email protected].
- 3Department of General Surgery, MCM Comprehensive Specialized Hospital, Addis Ababa, Addis Ababa, Ethiopia.
- 4Myungsung Medical College, Addis Ababa, Ethiopia.
- 5Department of Pediatric Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Abstract
Introduction and importance
Second primary malignancies are a recognised long-term complication of childhood cancer. Osteosarcoma arising as a second malignancy is uncommon, and chest-wall involvement is rarer still, raising particular difficulties in achieving clear margins, reconstructing the thoracic wall, and separating a new tumour from recurrence of the original disease. We report chondroblastic osteosarcoma of the rib arising nine years after treatment for high-risk neuroblastoma.Case presentation
A 12-year-old girl, treated at the age of three for stage III, N-MYC-amplified right adrenal neuroblastoma, presented with a two-week history of a painful right anterior chest-wall mass initially taken for a breast lump. Imaging showed an expansile mixed lytic-sclerotic lesion of the right fourth rib with chest-wall and pleural extension, and core-needle biopsy confirmed chondroblastic osteosarcoma (SATB2 positive; hormone-receptor negative). After neoadjuvant chemotherapy on the EURAMOS-1 protocol, en bloc resection of the right third to fifth ribs was performed with a porcine acellular dermal-matrix reconstruction. Positive deep, lateral, and medullary margins prompted re-excision a week later, which achieved clear margins.Clinical discussion
Tumour necrosis of 80% indicated a Huvos grade II (poor) response, and, together with the initially positive margins, defined an unfavourable pathological profile. Radiotherapy during primary treatment was directed at the right adrenal region, ipsilateral to the later rib tumour, but the field and dose could not be retrieved, so a radiation-associated origin can be neither confirmed nor excluded; prior alkylating-agent chemotherapy is an alternative contributor.Conclusion
New musculoskeletal complaints in a childhood cancer survivor warrant prompt cross-sectional imaging to distinguish a second malignancy from benign change; positive margins after chest-wall resection should prompt early re-excision, which can still secure local control; and a poor histological response with positive margins marks a patient for intensified surveillance.
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BibTeX
@article{yeta2026chondroblastic,
title = {{Chondroblastic osteosarcoma of the rib as a second primary malignancy following neuroblastoma: a case report.}},
author = {Darrick L Yeta and Mikyas Befekadu Nigusse and Andinet Dessalegn Beza and Derek Harrison},
journal = {BMC surgery},
year = {2026},
month = jul,
doi = {10.1186/s12893-026-04094-6},
url = {https://europepmc.org/article/MED/42928164},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Chondroblastic osteosarcoma of the rib as a second primary malignancy following neuroblastoma: a case report.
AU - Darrick L Yeta
AU - Mikyas Befekadu Nigusse
AU - Andinet Dessalegn Beza
AU - Derek Harrison
PY - 2026
DA - 2026/07/01
JO - BMC surgery
DO - 10.1186/s12893-026-04094-6
UR - https://europepmc.org/article/MED/42928164
AB - Introduction and importance Second primary malignancies are a recognised long-term complication of childhood cancer. Osteosarcoma arising as a second malignancy is uncommon, and chest-wall involvement is rarer still, raising particular difficulties in achieving clear margins, reconstructing the thoracic wall, and separating a new tumour from recurrence of the original disease. We report chondroblastic osteosarcoma of the rib arising nine years after treatment for high-risk neuroblastoma.Case presentation A 12-year-old girl, treated at the age of three for stage III, N-MYC-amplified right adrenal neuroblastoma, presented with a two-week history of a painful right anterior chest-wall mass initially taken for a breast lump. Imaging showed an expansile mixed lytic-sclerotic lesion of the right fourth rib with chest-wall and pleural extension, and core-needle biopsy confirmed chondroblastic osteosarcoma (SATB2 positive; hormone-receptor negative). After neoadjuvant chemotherapy on the EURAMOS-1 protocol, en bloc resection of the right third to fifth ribs was performed with a porcine acellular dermal-matrix reconstruction. Positive deep, lateral, and medullary margins prompted re-excision a week later, which achieved clear margins.Clinical discussion Tumour necrosis of 80% indicated a Huvos grade II (poor) response, and, together with the initially positive margins, defined an unfavourable pathological profile. Radiotherapy during primary treatment was directed at the right adrenal region, ipsilateral to the later rib tumour, but the field and dose could not be retrieved, so a radiation-associated origin can be neither confirmed nor excluded; prior alkylating-agent chemotherapy is an alternative contributor.Conclusion New musculoskeletal complaints in a childhood cancer survivor warrant prompt cross-sectional imaging to distinguish a second malignancy from benign change; positive margins after chest-wall resection should prompt early re-excision, which can still secure local control; and a poor histological response with positive margins marks a patient for intensified surveillance.
SN - 1471-2482
ER -