Osteosarcoma with Orbital Metastasis in a Nigerian Child: A Case Report and Review of the Literature

  • MO Adekunle
  • IN Diaku-Akinwumi
  • AO Akinola
  • G Akinyosoye
Keywords: Bone malignancy, Childhood Tumour, Osteosarcoma, Orbit, Neoplasm Metastasis, Nigeria


Osteosarcoma is the most common primary bone tumour with a peak occurrence in adolescence. The occurrence of osteosarcoma in preadolescents is rare with a paucity of data in the developing world. Metastasis of osteosarcoma to the orbit is even a rarer presentation with few cases reported in the literature but to the best of the researchers’ knowledge, none of the previous cases had contralateral orbital metastasis to osteosarcoma. This is the first case report of orbital metastasis of osteosarcoma in Nigeria. The present case is presented for its rarity, to increase awareness and add to knowledge on the possibility of metastasis to contralateral orbit in osteosarcoma.


Marina N, Gebhardt M, Teot L, Gorlick M. Biology and therapeutic advances for paediatric osteosarcoma. The Oncologist. 2004; 9: 422-441.

Savage SA, Mirabello L. Using epidemiology and genomics to understand osteosarcoma etiology. Sarcoma 2011; 2011: 548151. https://doi.org/10.1155/2011/548151

Whelan J, McTiernan A, Cooper N, Wonk YK, Francis M, Vernon S, et al. Incidence and survival of malignant bone sarcomas in England 1979-2007. Int J Cancer.2012; 131: E508-E517. https://doi.org/10.1002/ijc/26426

Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. Cancer Treat Res 2009; 152: 3-13. https://doi.org/10.1007/978-1-4419-0284-9_1

Lee V. Bone tumours in childhood and adolescence. Paediatr Child Health. 2018; 28(4): 164-168. https://doi.org/10.1016/j.paed.2018.01.004

Engels EA. Cancer risk associated with receipt of vaccines contaminated within Simian virus 40: epidemiologic research. Expert Rev Vaccines 2005; 4: 197-206. https://doi.org/10.1586/14760584.

Carpenter DO, Bushkin-Bedient S. Exposure to chemicals and radiations during childhood and risk of cancer later in life. J Adolesc Health 2013; 52: S21-S29. https://doi.org/10.1016/j/jadohealth.2013.01.027

Tan ML, Choong PFM, Dass CR, “Osteosarcoma: conventional treatment vs. gene therapy,” Cancer Biol Ther 2009; 8: 106–117. https://doi.org/10.4161/cbt.8.2.7385

Rickel K, Fang F, Tao J. Molecular genetic of osteosarcoma. Bone. 2017; 102: 69-79. https://doi.org/10.1016/j.bone.2016.10

Gianferanti DM, Mirabello L, Savage SA. Germline and somatic genetics of osteosarcoma-connecting aetiology, biology and therapy. Nat Rev Endocrinol. 2017; 13: 480-491. https://doi.org/10.1038/nrendo.2017.16

Pan KL, Chan WH, Chia YY. Initial symptoms and delayed diagnosis of osteosarcoma around the knee joint. J Orthop Surg.2010; 18: 55-57. https://doi.org/10.1177/230949901001800112

ElKordy MA, El Barache TS, ElSebai HI, KhairAlla SM, Amin AAE. Osteosarcoma of the jaw: challenges in the diagnosis and treatment. J Egypt Natl Canc Inst 2018; 30: 7-11. https://doi.org/10.1016/j.jnci.2018.02.001

Alhubran AH, Griffin A, Pintilie M, Blackstein M. Osteosarcoma in adolescents and adults: survival analysis with and without lung metastases. Ann Oncol 2009; 20: 1136-1141. https://doi.org/10.1093/annonc/mdn731

Panikkath R, Radhi S, Lim SY, Thankam M, Quattromani F, Jumper CA, Metastasis of lung cancer through Batson’s plexus: very rare but possible. The Southwest Respiratory Critical Care Chronicles 2013; 1: 45-49. https://doi.org/10.12746/swrccc.v1i4.84

Misra A, Misra S, Chaturvedi A, Srivastava PK. Osteosarcoma with metastasis to orbit. Br J Ophthalmol 2001; 85: 1387-1388. https://10.1136/bjo.85.11.1384C

Lin P, Chen W, Hsieh Y, Chen WY, Chen T. Orbital metastatic osteosarcoma. J Chinese Med Assoc 2005; 68: 286-289. https://doi.org/10.1016/s1726-4901(09)70153-4

Attili SVS, Jain A, Saini KV, Batra U, Babu KG, Sajeevan KV, et al. Orbital metastasis: a rare presentation of osteosarcoma. Int Ophthalmol. 2008; 28: 433-436. https://doi.org/10.1007/s10792-007-9154-6

Rajabi MT, Jafari H, Hosseini SS, Tabatabaie SZ, Rajabi MB, Amoli FA. Orbital metastasis: a rare manifestation of scapular bone osteosarcoma. J Ophthalmic Vis Res 2014; 9: 517-519. https://doi.org/10.4103/2008-322x.150834

American College of Radiology. ACR Appropriateness Criteria: pri¬mary bone tumours. https:// acsearch.acr.org/docs/69421/Narrative/ Accessed May 2021

Ren HY, Sun LL, Li HY, Ye ZM. Prognostic significance of serum alkaline phosphatase level in osteosarcoma: A meta-analysis of published data. Biomed Res Int 2015; 2015: 160835. https://doi.org/10.1155/2015/160835

McCarville MB, Christie R, Daw NC, Spunt SL, Kaste SC. PET/CT in the evaluation of childhood sarcomas. Am J Roentgenol 2005; 184: 1293-1304. https://doi.org/10.2214/ajr.184.4.01841293

van der Spuy DJ, Vlok GJ. Osteosarcoma: Pathology, staging and management. South Afr Orthopaed J 2009; 8: 69-78.

Tiwari A. Current concepts in surgical treatment of osteosarcoma. J Clin Orthop Trauma 2012; 3: 4-9. https://doi.org/10.1016/j.jcot.2012.04.004

DeLaney TF, Park L, Goldberg SI, Hug EB, Liebsch NJ, Munzenriden JE, Suit HD. Int J Radiat Oncol Biol Phys 2005; 61; 492-498. https://doi.org/10.1016/j.ijrobp.2004.05.051

Meazza C, Scanagatta P. Metastatic osteosarcoma: A challenging multidisciplinary treatment. Expert Rev Anticancer Ther 2016; 16: 543-556. https://doi.org/10.1586/14737140.2016.1168697

Kager L, Zoubek A, Kastner U, Kempt-Bielack B, Potratz J, Kotz R. Skip metastases in osteosarcoma: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol 2005; 24: 1535-1541. https://doi.org/10.1200/JCO.2005.04.2978

Adeniran JJ, Samuel EU, Dike OC, Olayinka SO, Ayokunle O, Nnosu OE, Abdulkarem FB, et al. Bone malignancies in Orthopaedic Hospital Igbobi Lagos, Nigeria. Niger Postgrad Med J 2014; 21: 66-67.

Kim T, Chung HS, Cho W, Jeon D, Chung S. Is osteosarcoma between the two peak ages different? J Cancer Ther 2018; 9: 64-78. https://doi.org/10.4236/jct.2018.91008

Parthasarathy A. Bone Tumors. In. Partha’s Fundamentals of Paediatrics. 2013. https://books.google.co.za/books/about/partha_s_fundamentals_of_. Accessed 12 October 2018.

Newman NM, DiLoreto DA. Metastasis of primary osteogenic sarcoma to the eyelid. Am J Ophthalmol 1987; 104: 659-660. https://doi.org/10.1016/0002-9394(87)90182-6

Lees V. A case of metastatic osteosarcoma in the choroid. Br J Ophthalmol 1947; 31: 713-16.

Agrawal A. Osteosarcoma metastasis to the orbit presenting as severe proptosis following trivial trauma. J Clin Ophth Res 2014; 2: 155-157. https://doi.org/10.4103/2320-3897-138862

Salah S, Ahmad R, Sultan I, Yaser S, Shehadeh A. Osteosarcoma with metastasis at initial diagnosis: current outcomes and prognostic factors in the context of a comprehensive cancer centre. Molecular Clin Oncol 2014; 2: 811-816. https://doi.org/10.3892/mco.2014.325

Schwarz R, Bruland O, Cassoni A, Schomberg P, Bielack S. The role of radiotherapy in osteosarcoma. Cancer Treat Res. 2009; 152: 147-164. https://doi.org/10.1007/978-1-4419-0284-9_7

Case Report