Asymptomatic popliteal vein tumor embolism in a patient with osteosarcoma in the left tibia

Abstract

A 14-year-old male with osteosarcoma (OS) in the left tibia achieved complete remission after neoadjuvant and adjuvant chemotherapy and total resection of the primary tumor; however, he experienced pulmonary relapse twice. FDG PET-CT after wide resection of the left lung for the second recurrence showed a tumor embolism in the left popliteal vein, although he did not exhibit any embolism-associated symptoms. He underwent six courses of chemotherapy with gemcitabine and docetaxel, resection of the tumor-embolism-containing vessel with saphenous vein bypass graft, and postoperative oral pazopanib treatment. However, he experienced a third recurrence in the right lung. The patient was alive without disease while on treatment at 1 year and 6 months after the third recurrence. Since the incidence of tumor embolism is relatively higher in OS, FDG PET/CT examination is recommended for a systemic monitoring of this disease.