Large pulmonary metastasis or primary lung cancer? Management particularities of an osteosarcoma case

Osteosarcoma is the most frequent malignant tumor of the bone which is diagnosed most frequently in children or young adults, with a high possibility of metastasis, especially in the lung. We report a case of 39-year male patient with a history of an above-the-knee left limb amputation after tibial osteosarcoma with no follow-ups in the last two years and with an expansive apical and left paramediastinal mass found on chest X-ray. We performed a bronchoscopy and the histopathological diagnosis of swabbed samples was fibroblastic type of classic osteosarcoma with focal areas of telangiectatic osteosarcoma and areas showing giant cells. The particularity of the case consisted in the challenge of establishing the origin of pulmonary mass. Whilst increased dimensions militated for a primary pulmonary neoplasm, the histological examination ascertained the metastatic etiology of the tumor.