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Case Report Open Access

Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report

  • Authors:
    • Bin Chen
    • Li Zhao
    • Lujiao Chen
    • Wan Sun
    • Jun Yu
    • Jin Xu
  • View Affiliations / Copyright

    Affiliations: Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang 31200, P.R. China, Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310000, P.R. China, Department of Nuclear Medicine, Zhejiang University Mingzhou Hospital, Ningbo, Zhejiang 315000, P.R. China, Department of Radiology, Zhuji People's Hospital, Zhuji, Zhejiang 311800, P.R. China
    Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 485
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    Published online on: August 18, 2025
       https://doi.org/10.3892/ol.2025.15231
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Abstract

With the wide application of radiation therapy for malignant tumors and the continuous improvement of comprehensive treatment effect, the survival period of patients has been prolonged, while the incidence of radiation‑induced osteosarcoma (RIOS) has gradually increased. Compared with primary osteosarcoma, RIOS has a higher degree of malignancy and poorer prognosis, severely impacting patient survival. Currently, there are relatively few case reports on RIOS and the understanding of its imaging characteristics remains incomplete. A patient with esophageal cancer who was found to have thoracic paravertebral masses six years after receiving radiotherapy was encountered at Zhuji People's Hospital (Zhuji, China). Computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT all indicated the presence of the malignant tumors. Subsequently, the patient was hospitalized for CT‑guided puncture biopsy of thoracic paravertebral masses. Through multidisciplinary discussions in the departments of Medical Oncology, Orthopedics, Radiology and Pathology, a consensus was finally reached on RIOS. In conclusion, RIOS is a severe and relatively rare complication of radiotherapy with a poor prognosis. In its early stage, it is easily confused with bone changes after radiotherapy and appearance deformities after surgery. Neoplastic bone is the primary imaging feature of RIOS of esophageal cancer. By combining the patient's radiotherapy history and laboratory examinations, the diagnostic accuracy for this disease could be improved.
View Figures

Figure 1

Target area and dose distribution map
after esophageal cancer surgery. The yellow area represents the
4,500 cGy dose distribution area, which highly overlaps with the
osteosarcoma area.

Figure 2

CT images of esophageal cancer. (A)
Plain scan shows focal thickening of the middle thoracic esophagus.
(B and C) Enhanced images show moderate enhancement of the middle
thoracic esophagus (the yellow arrow points at the cancerous
lesion). (B) Arterial phase: The lesion exhibits mild enhancement,
with the degree of enhancement generally lower than that of the
normal esophageal wall. (C) Venous phase: The lesion shows
persistent enhancement, slightly increased compared to the arterial
phase but still less than the normal esophageal wall
enhancement.

Figure 3

CT images after the surgery for
esophageal cancer. (A) Mediastinal window on chest CT plain scan
indicating no significant thickening of the anastomotic canal wall.
(B) No obvious bone abnormalities of the thoracic vertebrae were
found in the bone window (the yellow arrow indicates the
anastomosis site after surgery).

Figure 4

Postoperative CT images of esophageal
carcinoma. (A) Thoracic spine CT scan shows no significant
thickening of the anastomotic wall (fine arrow), with irregular
dense shadows observed near the right edge of the thoracic vertebra
(coarse arrow); the margins are indistinct and blurred, with patchy
high-density tumor ossification visible internally. (B) Thoracic
spine CT scan reveals no significant thickening of the anastomotic
wall (fine arrow), with irregular dense shadows near the right edge
of the thoracic vertebra (coarse arrow) and a central patchy
low-density area. Sclerosis of the adjacent vertebral bodies and
ribs is also present. CT, computed tomography

Figure 5

MR image of after esophageal cancer
surgery. (A) T2WI shows that no obvious thickening of the
anastomotic tube wall (thin arrow) and mass shadows (thick arrow)
with patches of low signal can be seen inside. (B) T1WI shows that
the lesion is located near the right margin of thoracic vertebrae
3–5 with a less equal signal. (C) Enhanced transverse view and (D)
enhanced sagittal view scans demonstrate the lesion (indicated by
the thick arrow) exhibiting marked heterogeneous enhancement, with
the peripheral enhancement significantly more pronounced than the
central area. The margins are ill-defined and the lesion involves
adjacent vertebral bodies and ribs. T1WI, T1-weighted imaging.

Figure 6

18F-FDG-PET/CT scan. Upper
left, CT axial image demonstrating an irregular, dense lesion near
the right lateral border of the thoracic vertebrae (T3-T5),
measuring ~2.4×3.9×4.5 cm, with indistinct and blurred margins.
Upper right, PET image showing a conspicuous irregularly shaped
high FDG uptake area corresponding to the lesion seen on the CT,
with SUVmax/average=14.8/9.7. Lower left, fused PET/CT image
revealing complete concordance between the abnormal dense lesion on
CT and the high FDG uptake region on PET. Lower right, PET Maximum
Intensity Projection image displaying the distribution of FDG
uptake throughout the body, with a prominent hypermetabolic lesion
in the thoracic region (corresponding to T3-T5). FDG,
fluorodeoxyglucose; PET, positron emission tomography; CT, computed
tomography; SUV, standardized uptake value; max, maximum; avg,
average.

Figure 7

Puncture pathology showed that the
lesion tissue contained anaplastic sarcoma cells and osteoid matrix
produced by sarcoma cells. The anaplastic sarcoma cells were
fusiform, round-like, with medium eosinophilic cytoplasm, obvious
nuclear atypia and giant tumor cells. Eosinophilic neoplastic
braided bone and osteoid matrix can be seen in the sarcoma cells
and there is no osteoblast coating around it (H&E;
magnification, ×100).

Figure 8

Immunohistochemical images: (A) Ki67
(~50% of cell nuclei are positive); (B) CD138 cell membrane
positive (magnification, ×100; scale bars, 200 µm).
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Copy and paste a formatted citation
Spandidos Publications style
Chen B, Zhao L, Chen L, Sun W, Yu J and Xu J: Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report. Oncol Lett 30: 485, 2025.
APA
Chen, B., Zhao, L., Chen, L., Sun, W., Yu, J., & Xu, J. (2025). Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report. Oncology Letters, 30, 485. https://doi.org/10.3892/ol.2025.15231
MLA
Chen, B., Zhao, L., Chen, L., Sun, W., Yu, J., Xu, J."Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report". Oncology Letters 30.4 (2025): 485.
Chicago
Chen, B., Zhao, L., Chen, L., Sun, W., Yu, J., Xu, J."Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report". Oncology Letters 30, no. 4 (2025): 485. https://doi.org/10.3892/ol.2025.15231
Copy and paste a formatted citation
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Spandidos Publications style
Chen B, Zhao L, Chen L, Sun W, Yu J and Xu J: Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report. Oncol Lett 30: 485, 2025.
APA
Chen, B., Zhao, L., Chen, L., Sun, W., Yu, J., & Xu, J. (2025). Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report. Oncology Letters, 30, 485. https://doi.org/10.3892/ol.2025.15231
MLA
Chen, B., Zhao, L., Chen, L., Sun, W., Yu, J., Xu, J."Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report". Oncology Letters 30.4 (2025): 485.
Chicago
Chen, B., Zhao, L., Chen, L., Sun, W., Yu, J., Xu, J."Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report". Oncology Letters 30, no. 4 (2025): 485. https://doi.org/10.3892/ol.2025.15231
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